107 



Subject No. 1. 



The effect of walking upstairs (twenty steps) was compared 

 in this person with the disturbances occurring in sleep. The 

 pulse rate was raised from 80 to 90-95, the systolic from 120 to 

 140, and the diastolic pressure from 80 to 90; the observations were 

 made while the ascent was being continued, not after its cessa- 

 tion. Ordinary walking exercise on a fairly level road caused 

 comparatively slight changes in the heart rate and the blood 

 pressure. In the same subject some days previously atropine 

 (1/50 grain hypodermically) raised the pulse rate from 81-82 to 

 130, with systolic and diastolic pressures of 135 and 75-80 respec- 

 tively, as compared with 115 and 70 before atropine. Abdominal 

 straining (expulsive efforts) raised the systolic blood pressure only 

 a few millimetres. 



It is evident that in this individual the stress on the circula- 

 tory system was vastly greater during such disturbed sleep as is 

 described above, than under the conditions of ordinary easy life 

 with avoidance of sudden violent effort, emotional excitement, 

 etc. The actual height of pressure attained during the disturbed 

 sleep was, no doubt, decidedly higher than as measured after 

 awaking when it is declining with some rapidity. 



Subject No. 2. 

 Subject in bed in afternoon. While asleep he had lain on the 

 right side with the right arm pressed on by the head so that 

 the right radial pulse was abolished. The left radial pulse 

 was found to be very fast and the artery large and strikingly 

 tense, immediately after awaking ; these unmistakable evidences 

 of an extensive rise of blood pressure speedily passed off. The 

 sleeper reported having been under the influence of a pronounced 

 nightmare, with the illusion of his lying prone near the door of 

 a house while he heard a visitor approaching along the drive ; 

 he had vivid and distressing sensations of ineffectual efforts to 

 rise. The nightmare was no doubt determined by the posture, 

 the pressure on the arm, and the ischaemia caused. After awaking 

 numbness and tingling were felt in the right !iand, while the 

 radial artery became very large and the skin flushed — evidently 

 after-effects of the ischaemia. 



Subject No. 3. 



A subject, who had some symptoms of gastro-intestinal dis- 

 turbance but was pursuing his usual avocations, had in the course 

 of a night of broken sleep a dream in which he felt lively resent- 

 ment at the irritating conduct of an official on a public occasion 

 — a vivid dream but not distinctly a nightmare ; there was no 

 sense of fear, oppression, ineffectual effort, etc. On his awaking 

 it was found that there was no sense of palpitation, no sweating, 

 and no subjective alteration in respiratory sensations; no marked 

 change in the respiratory movements was observed. But the 

 cardiac impulse was greatly increased in force and felt over a 

 larger area than usual in this person. The pulse was accelerated 

 from a normal rate of 70-80 to 90-95. But the most notable change 

 was a greatly raised blood pressure with an extensive pulse pres- 

 sure, as shown by digital examination of the radials; the arteries 

 were large and tense, obliteration difficult, and the range of the 

 pressure variations at each beat palpably large. When examined 

 fifteen minutes later these altered conditions were practically gone. 



Some hours later another dream took place, the details of 

 which were not clearly remembered. Similar phenomena, in 



