NIGHTMARE.
Preventive treatment is often successful; a close scrutiny of the causes which were at work in former attacks will generally give the clue to the management of the patient's feeding, sleeping or mental work, which will prevent the recurrence of the disorder. As a rule it is produced by the presence of a considerable amount of undigested or indigestible food lying in the stomach, and this is very often produced by late suppers in those who dine early. The habit of occupying the mind by severe exercise up to the moment of lying down may he the cause of the attacks. Severe business worry, prolonged grief or anxiety and alcoholic excesses may be the cause. Some patients are liable to experience attacks when they turn over upon their hacks in sleep, or when the weight of the body, sinking gradually into the depths of a soft feather bed, causes the head to slip off the pillow, or when the feet get cold.
Late dinners, which do away with the necessity for supper, a hard hair mattress, and a contrivance which awakes the patient the instant that he turns over upon his back, such as the tying of an empty cotton-reel across the back (i.e., over the spine), and the avoidance of indulging in severe
mental labour before retiring to bed, will generally prevent the attack. A full dose of Bromide of Potassium or, better still, Paraldehyde, Trional or Sulphonal will be worth trying when there are special reasons for suspecting an attack, and the feet should be kept warm.
When the attack comes on, the sooner the patient gets roused thoroughly the better. There is not much use in prescribing remedies which he is to use himself, as by the time he would be in a position to employ them the attack would have entirely passed away. He should be advised to get rapidly out of bed as soon as he is able, and dash some cold water upon his face or dip his head into a basin of water. When the attack tends to recur upon the patient's again lying down, he may induce vomiting, and insure the complete evacuation of the contents of the stomach. The friends of a patient who is subject to attacks of nightmare may be instructed to administer a cold douche, a whiff of Nitrite of Amyl or strong Ammonia.