incubus, ephialtis, pavor nocturnus. Oppressed breathing during sleep and sensation of load in the breast, and of suffocation; terrifick dreams, fantasies, apparitions, visionary encounters, and dangers; by which the person is at length awaked in agitation, palpitation, and sweats. It attacks generally the dormant in a supine posture. Some infants and children, during sleep, are also disturbed with anxious groans, and exclamation. The predisposing and occasional causes are, plethora; heavy suppers; ventricular crudity, indigestion, gluttony, flatulence; worms; head laid low in bed; intense application of mind, and various passions: symptomatick in some fevers, in hystericks, hypochondriasm, hydrocephalus, hydrothorax, aneurism, and polypi; sometimes is a prelude of apoplexy, epilepsy, &c.
Apoplexy.
Under this we shall aggroup several inferior species of vortex and stupor in the imperial seat of reason and motion; as lethargy, coma, carus, cataphora, vertigo. By apoplexy and suddenly, in the London registers, between one eightieth and ninetieth part of the community seem to be destroyed: and this mortality would be magnified by the addition of many who are reported as found dead. In the last 30 years of the preceding century, apoplexy and suddenly stands at 3010: Lethargy at 488: and megrims now omitted at 45. This thunderbolt of death, or in the phrase of one of the British poets, “that knocketh man down as butcher felleth ox,” is principally hostile to those advanced in years, and the aged: to those more especially of large heads and short necks, of corpulent habits, indolent life; to the full feeders, or the addicted to frequent intoxication. Medical observations also represent it as affecting more of the male than the female sex; as more predominant in winter and spring, especially on vernal heat succeeding winter cold; or moist rainy weather supplanting cold, and vice versa. It is also said to be more general and fatal in the city than the country.
Apoplexy may attack suddenly; in other cases it is preceded days, weeks, or even months before the shock by vertigo, obscure vision, noise in the ears, dullness of memory, faultering in the tongue, difficulty of articulation; in some the mouth is distorted, with transient torpidness or tremor of different muscular parts, headach, drowsiness, night mare, nasal hemorrhage, flushing of the cheeks, lachrymation, decay of strength, alteration of countenance and voice. In the paroxism the patient, instantaneously stunned, falls down, with suspension of the functions of the external and internal senses, of voluntary motion, and of voice and speech; and with muscular relaxation; at the same time the pulse and respiration remain nearly in the natural state, excepting that there is generally a stertor in breathing, resembling a profound sleep from gross intoxication; and also, as in most soporous diseases, the circulation slow. These unmolested functions of the heart and lungs distinguish it from syncope. In the duration and severity of the symptoms, there are different gradations. Some lay in this lethargic state insensible to every object and impression: some when spoke to, only groan or make dumb signs: some, after a short time, are able to articulate: in some, there is froth at the mouth: the colour of the face is various, sometimes flushed, sometimes however pale; and the signs in authors between the sanguine and serous apoplexy are extremely ambiguous.
It often proves fatal at the first stroke; few can survive many attacks. Death, recovery, or transition into palsy, are generally decided within seven days. In magnitude of danger, perhaps no other disease can contend with this formidable antagonist: but I shall leave it to others to graduate the apoplectick scale. Some recover; in others it ends in death or hemiplegy, which is but a sad alternative and capitulation for life: and too frequently is accompanied with some lesion of the mental functions. Even of those who recover, they are in danger of relapses from intemperance, and errors in the non-naturals. The violence and contumacy of the symptoms indicate the degrees of peril: the less the functions of internal and external sense, and of voluntary motion are injured, our hopes are more flattering; whereas total insensibility, froth at the mouth, cold sweats on the breast and face, cold breath, involuntary excretion of feces and urine, are harbingers of impendent wreck in the apoplectic whirlpool.
Of lethargy, coma, carus, cataphora.
These denote different degrees of profound deep sleep without delirium. Authors have often confounded them with the febrile class, especially the “lusus naturæ” of remittents. To this irresistible torpor and drowsiness, even at meals or in conversation, many corpulent and fat persons are subject. We also read in authors of some extraordinary instances of profound long protracted sleep, from which it was impossible effectually to rouze the person. The vertigo has also been distinguished into simplex, scotomia, caduca. In this disease all objects, although at rest, seem to whirl round; sometimes with headach, flushing of the face, noise in the ears; and if not supported, the patient often falls down. It is commonly fugacious, and momentary; seldom above a minute; and in some diseases is symptomatick. The prognostick may be deduced from that of apoplexy.
Of the predisposing and occasional causes of apoplexy, lethargy, coma, carus, cataphora, and vertigo: hereditary; short neck; plethora, general or partial, sanguine or serous, especially sanguineous plethora in the vessels of the brain; tight neckcloaths; pressure on the descending aorta, cava; serous or sanguineous exudations or extravasations in the brain; compression of the medullary substance, or of the origin of the nerves; suppression of habitual evacuations or hemorrhages, nasal or hemorrhoidal; habitual venesection neglected; old ulcers dried up; full and long continued inspiration loading the vessels of the head; blood forced on the brain by violent efforts of coughing, vomiting, fecal expulsion, exercise, venery, stooping the head; salivation suddenly suppressed by cold; foul stomach, gluttony, surfeits, luxurious living, and sedentary life; fatness, corpulency; intoxication, sottish potations; violent passions of mind irascible or stimulating, and also depressing, as anger, ambition, chronic melancholy and cares; intense meditation and study; intemperate lust in old age; noxious vapour from liquors in fermentation, from charcoal, quicklime, and new-plastered walls; particular effluvia and odours concentrated in large quantity; crowded rooms filled with animal steams from the lungs; thunder; sometimes epidemick state of the air and elements, or perhaps celestial influences not yet explained; intense cold; warm baths; blood rarified and expanded; insolation; some narcotick poisons, as opium, hyoscyamus, cicuta, laurus, belladonna, and some fungi: obstructed circulation through the lungs and heart, from asthma, polypi, ossifications of the large blood vessels or valves, and particularly of the right ventricle; external injuries of the head; concussion, fractures. The most frequent cause is, accumulation and congestion of blood in the brain: but sometimes, on dissection, no disease is discernible; and effusions in the brain do not always inflict apoplexy.