Liver abscess may be attended with insomnia.
Malta fever is often attended with a weariness from suffering with the various joint and nerve pains so that insomnia is often marked.
Even in trypanosomiasis insomnia may be present at first. Insomnia is also one of the early neurasthenic manifestations of pellagra.
Somnolence.—The disease in which this symptom is best known is sleeping sickness. The patient may go to sleep lying in the bright sunlight or in the midst of eating a morsel of food. These cases can be easily aroused but quickly drop off to sleep afterwards. They often deny that they were asleep. Later on in sleeping sickness the patient may sleep from 24 to 36 hours continuously and a more marked tendency to somnolence may be present by day than by night.
In the prodromal stage of leprosy somnolence is often marked and accompanied by a sensation of unaccountable weakness. Sweatings and accessions of fever may also be noted at this time.
In plague the rather stuporous state of the patient may give the impression of somnolence.
Cephalalgia, Rachialgia and Other Pains
Yellow fever is marked by pains in the lumbar region, the coup de barre of the French. It is as if the patient had been beaten over the small of the back with a bar of iron. The headache is rather orbital and is often excruciating. There are also frequently heavy, dull pains of the extremities.
Blackwater fever also has marked pains in the lumbar region giving expression to the kidney damage done by the haemoglobin detritus plugging the tubules.
In all forms of malaria, but especially in the paroxysms of malignant malaria, there are severe headaches and pains in the extremities. Intermittent neuralgia is often regarded as malarial.