190 
PATHOLOGY. 
nefs; the preffure fevere, and extending over the abdo¬ 
men; refpiratioii frequent, laborious conltridted; eyes 
fixed; fighing deep and violent; intellect undifturbed. 
E. vigilantium is entered on the authority of Rhodius 
and Sauvages. Sauvages gives us three other fpecies, 
but thefe are evidently fymptomatic of other affe£tions. 
It is a difeafe rarely met with, and generally arifing from 
fevere irritation of the nerves of the ftomach. 
a. Ephialtes nofturnus, (Oneirodynia gravans, Cullen.') 
■Nightmare, or elf-fquatting : produced during deep, and 
interrupting it with violent ftruggle and tremor; the 
preffure on the cheft feeming to be that of fome hideous 
monfter or phantom. This latter fympfom has given 
rife to the various popular names, wdiich, however differ¬ 
ent in different countries, all agree in exprefling the pre¬ 
fence of fome phantom, wizard, or goblin ; and which, as 
Dry den fays, 
Seeks fome love-wiider’d maid with fleep opprefs’d. 
Alights, and grinning fits upon her brealt. 
Befides the delufion of fupernatural fpirits, the imagi¬ 
nation at times difplays the calamities of life. The 
patient fancies himfelf to be ftruggling with flrong 
men, or to be in a houfe on fire, or in danger of being 
drowned; and, in attempting to run away from danger, 
or climb up a hill, he fancies he falls back as much after 
every ftep as he had advanced before. After he awakes, 
the terror excited by thefe frightful ideas leaves often a 
palpitation of the heart, with great anxiety and languor, 
and fometimes a tingling of the ears, and a general tremor. 
Many abfurd explanations have been given ofthe phenome¬ 
non of incubus, which we fhall not flop to detail. It is 
now generally agreed that the feat of the nightmare is 
principally in the ftomach. It is well afcertained that 
fome forms of epilepfy, and of hyfterical fits, originate 
from diforder in that vifcus ; and fo great a fimilarity 
exifts between the difeafes, that Galen confidered the in¬ 
cubus as a nocturnal or flight epilepfy. People troubled 
with nervous and hypochondriac affeftions, and who 
have delicate or flatulent ftomachs, are more peculiarly 
fubjeft to this diforder; and it is obferved, that a heavy 
or flatulent fupper greatly aggravates the nightmare in 
thofe who are predifpofed to it. The fympathy of the 
ftomach with the head, heart, lungs, and diaphragm, is fo 
remarkable, that there can be no difficulty in referring 
the feveral fymptoms of the incubus to a difagreeable ir¬ 
ritation of the nerves of the ftomach. 
The incubus is moft apt to feize perfons when lying on 
their back, becaufe, in this pofition, on account of the 
ftomach and other abdominal vifcera prefling more upon 
the diaphragm, we cannot infpire with the fame eafe as 
when we fit up or lie on one fide. Further, in that fitua- 
tion of the body the food feems to lie heavier on the fto- 
mach, and wind in it does not feparate fo readily by the 
cefophagus and pylorus as in an ereft pofture, when thefe 
orifices are higher than the other parts of the ftomach. 
The nightmare occurs in the time of fleep, becaufe the 
ftrange ideas excited in the mind, in confequence ofthe 
difordered feelings of the ftomach, are not then correfited 
by the external fenfes as they are when w'e are awake ; nor 
do we, by an increafed refpiration or other motions of 
the body, endeavour to (bake off any beginning uneafy 
fenfation about the ftomach or breaft. The incubus ge¬ 
nerally occurs in thefirft fleep, and feldom towards mor¬ 
ning, becaufe at the earlier period the ftomach is more 
loaded with food, and thatin a more crudeand indigefted 
ftate than in the morning. A lefs degree, amounting 
only to frightful dreams, is almoft a conftant concomi¬ 
tant of overloaded ftomach in fome habits; and requires 
the fame treatment as Dyfpepfia, which fee. 
Genus V. Sternalgia, [from npvov, the breaft-bone,and 
pain.] Violent pain about the fternum, extending 
towards the arms ; anxiety, difficulty of breathing, and 
fenfe of fuftocation. (Angina pe&oris, Iieberden and 
Cullen.) Our nofologifts have given us two fpecies; but 
we are notfatisfied with their reafons for the diftinftion. 
They are, 
1. Sternalgia ambulantium, (Afthma artliriticum, 
Schmidt. Diaphragmatic gout, Butler.) Supervening 
fuddenly during exercife ; with tendency to fyncope ; 
relieved by reft. 
2. Sternalgia chronica. (Orthopnoea cardiaca, Saire. 
Syncope anginofa, Duncan and Barry.) The paroxyfms 
lefs violent, but of longer continuance; recurring fre¬ 
quently with great palpitation of the heart, excited by 
flight, and often unknown, caufes; and not relieved by 
reft. 
This dreadful diforder is found to attack men much 
more frequently than women, particularly thofe who 
have fliort necks, and are plethoric or corpulent. Al¬ 
though it is fometimes met with in perfons under the 
age of twenty, it more frequently occurs in thofe who 
are between forty and fifty. In flight cafes, and in the 
firlt ftage of the diforder, the fit comes on by going up¬ 
hill, up-ftairs, or by walking at a quick pace after a 
hearty meal; but as the difeafe advances, or becomes 
more violent, the paroxyfms are eafily excited by paflions 
of the mind ; by exercife even of the moderate kind; by 
fneezing, coughing, or {training at {tool. In fome cafes, 
the patient is attacked whilft fitting or (landing, without 
any previous exertion or obvious caufe. On a fudden, 
he is feized with an acute pain or tightnefs at the extre¬ 
mity ofthe fternum, inclining to the left fide, and ex¬ 
tending up into the arm, as far as the infertion of the 
deltoid mufcle, accompanied by a fenfe of fuftocation, 
great anxiety, and a dreadful conviction of the fatal 
tendency of this malady. This commonly continues for 
the (pace of an hour. 
In the firft ftage of the difeafe, the uneafy fenfation at 
the end of the fternum, with the other unpleafant fymp¬ 
toms, which feemed to threaten a fufpenfion of life by a 
perfeverance in exertion, ufually go off 7 upon the perfon's 
(landing (till, or turning from the wind. Dr. Parry 
dates, that bending the body in fome cafes increafes the 
pain ; and therefore the patient draws himfelf up ftraight, 
with the head fomewhat bent backwards. 
In a more advanced ftage, the paroxyfms do not fo 
readily recede, and are much more violent. During the 
fit, the pulfe finks in a greater or lefs degree, and be¬ 
comes irregular; the face and extremities are pale, and 
bathed in a cold fweat; and, for a while, the patient is 
perhaps deprived of the powers of fenfe and voluntary 
motion. People affeCted with this complaint often die 
fuddenly, but fome continue fubjeCt to it for upwards of 
twenty years. 
The caufe of this diftrefling malady is not clearly un- 
derftood; it was formerly fuppofed to be either a fpaf- 
modic affeCtion, or a caries of the fternum; after this, Dr. 
Parry dated that it was an oflification of the coronary ar¬ 
teries which fupply the mufcular fubftance of the heart 
with blood. This change of (truCture mull certainly 
render the heart unequal to the talk of circulating the 
unufual quantity of blood thrown upon it by bodily ex¬ 
ertions or paflions of the mind; and, as the oflification 
increafes, it muft at all times impede the circulation. 
Dr. Parry fupports this notion by diffeCtions ; but it is 
clear that Angina peCtoris often occurs and amends fpon- 
taneoufly, or is removed by medicines ; a confummation 
not poflible if the coronary arteries were oflified. 
Dr. Reeder, in his work on the Difeafes of the Heart, 
divides the caufes of Sternalgia into four claffes. i. An 
oflified, or otherwife difeafed, ftate of the coronary arte¬ 
ries, whereby their calibre becomes much diminiflied ; or 
an oflified condition of that portion of the aorta whereat 
thefe veflels are given off - , fo as to.leffen the diameter of 
their aortal orifices. 2. Oflification and enlargement of 
the valves of the heart, and of thofe placed at the origin 
of the aorta and pulmonary artery ; alfo morbid contrac¬ 
tion of the different apertures to which they are attached ; 
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