As to medicines, the whole round of so-called antispasmodics is usually tried by routine physicians. I have never seen them do any good. Iron and bitter tonics are indicated in cases of anæmia or exhaustion. As the disease is sometimes induced in children by the presence of worms in the alimentary canal, diligent inquiry should be made relative to symptoms indicating irritation from these parasites, and if they are found to exist, anthelmintics should be administered.
A case of intermittent nightmare, occurring every alternate night, in a young lady, was recently under my care. No exciting causes could be discovered, except the probable one of malaria. The affection yielded at once to the sulphate of quinia.
Ferrez[108] has published the details of a case of intermittent nightmare occurring in the person of a Spanish officer, who was attacked after passing forty-two nights at the bedside of a sick daughter. Every night, at the same hour, he was awakened by frightful dreams, which, irritating his brain, produced cramps, convulsive movements, an afflux of blood to the cerebral tissues, a sadness which he could not conquer, and a continual and powerful feeling of approaching death.
The patient, though of strong constitution, became enfeebled and emaciated. His countenance was pale, the pupils contracted, and his whole appearance showing the exhaustion consequent upon the battle which he was obliged continually to fight with his disease. He composed at this time some verses, describing in graphic terms the deplorable condition of his mind and body.
Gymnastics, temperance in eating and drinking, and the study of poetry, failed to give him relief. Finally he consulted Dr. Ferrez, who advised him to reveal his state to his family, who hitherto had been kept in ignorance of his malady, to continue his gymnastics moderately, not to eat in the evening, to drink only cold water, to use friction over the whole surface of the body, to apply mustard plasters to the extremities, to sleep with his head elevated and uncovered, to bathe his head frequently during the night with cold water, to give up the study of poetry, and to devote himself to mathematics and political economy. These measures were rigorously carried out; but his daughter, who had been the involuntary cause of his disease, prescribed a better remedy than all the others. She had him waked at midnight, before the occurrence of his paroxysm, and thus broke up the habit.
Perhaps no one medicine is so uniformly successful in the ordinary forms of nightmare as the bromide of potassium, administered in doses of from twenty to forty grains, three times a day. I have seen a number of cases which had resisted all hygienic measures, and the simple removal of the apparent cause, yield to a few doses of this remedy.
When the affection has lasted a long time, it is more difficult to break up the acquired habit. In these cases, the plan so successfully employed by the daughter of the Spanish officer will almost invariably succeed.
Finally, persons subject to nightmare should so train the mind as to employ the intellectual faculties systematically, by engaging in some study requiring their full exercise. The action of the emotions should be as much as possible controlled, and the reading of sensational stories, or hearing sensational plays, should be discouraged. By severe mental training, individuals can do much to regulate the character of their dreams. It is a well-recognized fact, that intense thought upon subjects which require the highest degree of intellectual action is not favorable to the production of dreams of any kind.