CHAPTER III.
REMEDIES FOR INSOMNIA.
| O, true apothecary! Thy drugs are quick. —Romeo and Juliet. |
An occasional attack of wakefulness may fall to the lot of any one as a consequence of the various disturbances of health or equanimity of mind to which all are liable. Occurring as an accident in a state of health, it produces merely a feeling of lassitude and weariness during the subsequent day. This soon disappears, after a night of refreshing sleep, and the subject is nothing worse for the incident. But the recurrence of the disorder is a thing to be deprecated, not only for the reason that it denotes a departure from the physiological order of life, but because its frequent repetition prevents the adequate repair of the tissues of the body. The great function of nutrition suffers as a consequence, and the patient rapidly falls into a condition of premature old age. When this takes place as a result of some temporary error of hygiene, or as a consequence of diseases which admit of successful treatment, the patient may be restored to health by judicious management, but lost youth and elasticity of the tissues can never be fully regained. The most formidable cases of insomnia are those for which no adequate cause can be recognized in the habits, mode of life, and state of health of the patient. Grave and permanent disorder of the brain is then to be feared. Such wakefulness is a frequent precursor of acute meningitis in children and adults. It frequently ushers in the early, insidious, formative stage of tubercular meningitis, and of the infective fevers—notably typhoid fever. It forms one of the most suspicious symptoms among the introductory phenomena of insanity; and during the course of protracted diseases, its intrusion is an omen of most unfavorable augury. It will, therefore, be found useful to consider with some degree of detail the circumstances under which insomnia may occur, and the best means of averting its onset.
A severely logical reference to previous doctrines regarding the condition of the brain during sleep, has led many authors to consider the therapeutical treatment of insomnia chiefly as a matter of modification of the cerebral circulation. Sleep has been supposed to depend upon a comparatively bloodless state of the brain, and wakefulness upon the contrary state. For such theorists the treatment of insomnia consists very simply in the use of agents which are supposed to be efficacious in reducing the flow of blood through the head. Tourniquets, placed upon the carotid arteries, occupy a position of great honor in the armamentarium of such people. Recognizing the fact that changes in the force of the circulation accompany and sustain every change in the activity of the cerebral cortex, we, however, attach the greatest importance to the condition of the nervous substance itself. For a clear understanding of the proper mode of medication, it is important to ascertain whether the cerebral substance is in a state of normal activity, or whether it is in a state of healthy, but excessive, activity, or whether its seeming excitement is merely the result of irritable weakness. Since these opposite conditions may declare themselves during the course of any disease in which insomnia may become a troublesome phenomenon, it is impossible to make a classification of diseases upon the basis of these different states of the brain. It will, therefore, be found more useful to consider the subject of sleeplessness as it ordinarily presents itself during the clinical progress of the several forms of disease. It will, then, appear that the type of insomnia is liable to variation with the course of each individual malady; and its treatment must vary accordingly.
Before proceeding to a discussion of the therapeutics of insomnia in connection with particular diseases, it will be advantageous to pass briefly in review the different remedies which are useful in the treatment of wakefulness. These may be divided into two classes: Nervous stimulants, and nervous sedatives. Among the first may be also reckoned food, heat, baths, and counter-irritants. Like all nervous stimulants, they promote the complete and harmonious action of all parts of the nervous system, favoring that equilibrium of the circulation which is most favorable to the development of sleep. The second class of agents comprises all such remedies as act directly upon the nervous tissue of the brain, depressing its functional activity, and hushing to rest those particular organs which, by their undue excitement, serve to keep the remainder in a state of wakefulness. All these substances produce decided effects upon the spinal cord and the peripheral nerves, but it is their operation upon the brain which principally interests us in connection with insomnia.
| Nervous Stimulants. | Nervous Sedatives. | |
| Heat. Baths. Massage. Electricity. Counter-irritants. Food. Digitalis. Camphor. Musk. Valerian. Cannabis indica. Belladonna. Hyoscyamus. Stramonium. Phosphorus. Acids. Opium. | Cold. Alcohol. Paraldehyde. Ether. Chloroform. Chloral. Butylchloral hydrate. Amyl nitrite. Opium and opiates. Bromides. Hops. Gelsemium. Conium. |
NERVOUS STIMULANTS.