It is sometimes remarked that instead of favoring sleep the bromides only increase wakefulness. In such cases opiates and alcoholic stimulants are usually indicated.
Hops.—The principal sedative constituent of this plant is the yellow glandular powder found in the strobiles; this is called lupulin. Hops do not exhibit any directly narcotic property; but they serve to allay nervous excitement, and thus favor the occurrence of sleep. They are principally useful in cases of irritability of the bladder and sexual organs; in dyspepsia caused by irritable weakness of the stomach; and in the exhaustion of delirium tremens. The infusion is the best preparation for internal use. It may be taken in doses of one or two ounces, as required. Lupulin may be given in doses of ten grains or more. Its fluid extract is prescribed, fifteen or twenty minims in sweetened water whenever needed. The best method, however, of securing the beneficial effects of the medicine consists in the administration of a mild beer that is rich in hops. A glass at bedtime often forms a sufficient hypnotic.
Gelsemium is a very powerful agent for depressing the pulse and the functional activity of the spinal cord. It thus favors the induction of sleep in cases attended with violent excitement, such as may be witnessed in acute mania. It has been employed in the treatment of delirium tremens; but the poisonous qualities of the plant render its use somewhat dangerous. The toxic effects are sometimes developed quite suddenly, and in a manner very alarming to the laity. For these reasons it is not to be recommended as a soporific, unless the patient can be continually under the eye of the physician or of an intelligent nurse.
Conium has been found useful in the insomnia of mania, not through any narcotic property of its own, but by reason of its sedative effects upon the spinal cord and nerves. Under its influence the excitement of the patient is so far reduced that other hypnotic remedies can produce their effect. For this purpose Squibb’s fluid extract, in doses of about one-third of a drachm, or one-sixtieth of a grain of coniine, may be given sufficiently often to repress excitement. The alkaloid may be given hypodermically, and in gradually increasing doses. With it should be associated other remedies, like hyoscyamus and chloral hydrate, in order to procure sleep.[49]
CHAPTER IV.
TREATMENT OF INSOMNIA IN PARTICULAR DISEASES.
| Take thou this phial, being then in bed, And this distilled liquor drink thou off; When presently, through all thy veins shall run A cold and drowsy humor, which shall seize Each vital spirit. —Romeo and Juliet. |
Excluding from consideration all cases of insomnia arising from painful injuries or diseases of the external portions of the body, which belong to the province of surgical therapeutics, we may profitably commence with the variety of wakefulness that is excited by disorder of the brain and its membranes. This includes the different forms of meningitis, the cerebral disturbances which constitute insanity, cerebral exhaustion, and chronic alcoholism.