Much relief in the insomnia of children can be obtained from the use of lukewarm baths at bedtime. Supper should be a light but sufficient meal. Every disorder of digestion should be regulated as it occurs. Painful affections may be quieted with Dover’s powder. Feverish and irritable conditions yield frequently to aperients, or to gelsemium and quinine. Night terrors and screaming fits should be calmed with chloral hydrate and the bromide of sodium. As a general sedative and hypnotic for children hyoscyamus has an excellent reputation. It may be given in considerable doses with perfect safety and the best results. For patients in early life it seems to fill the place occupied by cannabis indica in the medication of adults.
Insomnia in old age.—The highest physical perfection is reached before the fortieth year of life. Between this age and the forty-fifth year man’s vigor begins to decline. The power of accommodation diminishes, necessitating the use of spectacles; adipose tissues begin to load the body; the hair grows thin, and begins to bleach. The processes of nutrition and of disassimilation become more sluggish; the appetites and passions gradually subside. Sometimes the moderation of nervous excitability thus effected permits indulgences of the appetite for food that were impossible during earlier years—the nervous dyspeptic can tolerate dainties which would formerly have been unendurable. Less disturbed by the solicitations of sense, the powers of reasoning and of judgment enlarge their authority. Under favorable circumstances this period of life may continue for about twenty years, when old age develops. From the sixtieth to the eightieth year the progress of decline is rapidly accelerated, and life is normally terminated between the eightieth and eighty-fifth years of existence. The rare examples of greater longevity are too few in number to warrant the assumption that a century of years is the physiological complement of life.
As old age advances, the time of sleep is slightly abridged. The moderated activity of the body requires only a diminished rate of repair to make good the waste of the tissues. Less sleep, therefore, is needed. But the liability of age to the incidence of arthritic diseases, rheumatism, and disorders of the heart, blood vessels, digestive apparatus, and urinary organs, renders the period of decline particularly subject to those varieties of sleeplessness which depend upon such derangements of health. The nutrition of the brain suffers under such circumstances, and the substance of the organ becomes morbidly irritable. Insomnia among the aged often owes its cause to these unwholesome conditions. The biography of the celebrated Carlyle affords numerous illustrations of this variety of wakefulness. Disease of the cerebral blood vessels sometimes originates a series of changes differing only in degree and intensity from the classical type of chronic periencephalitis. This is characterized by many of the minor phenomena of general paresis, only occasionally rising to the level of that disease. Wakefulness is one of the most troublesome symptoms of this disorder. Its management requires attention to all the details of excretion and nutrition. The diet must be carefully selected with reference to failure of the digestive function. Milk and water should be preferred for drink, and the great emunctory organs of the body must be carefully stimulated and sustained. A judicious choice of climate may accomplish much for the comfort of the patient. The mild, insular climate of Florida, or of New Providence, or of the Sandwich Islands, affords superior advantages for the relief of sleepless sufferers in the northern temperate zone of the American continent, who need the soothing influence of a continual open air bath.
During the latest stages of decline, when the cortex of the brain has become considerably atrophied, the opposite of wakefulness is experienced. Intellectual operations become less vigorous, and the patient passes lengthening periods of time in sleep. This is a genuine relapse into the apathy of infancy. The apparatus of thought is worn out, and the old man sinks gradually into the sleep from which there is no awakening.
The treatment of insomnia, therefore, resolves itself into the removal of all special and temporary causes of wakefulness, with attention to the general hygiene of the patient, and careful regulation of his diet, habits, and occupation. Pain must be quelled with anodynes. Cerebral excitement must be calmed, in sthenic cases, with anti-spasmodics and sedatives—in asthenic subjects it must be overcome with food and nervous stimulants. Since many patients present a combination of these apparently opposite conditions, there is room for a great display of penetration and tact in the management of complex cases. While seeking for the immediate relief of present suffering, the ulterior consequences of treatment must always be kept in view, and the particular cachexia or dyscrasia must be thoroughly appreciated by the physician in his choice of remedies.
CHAPTER V.
DREAMS.
| Behold, this dreamer cometh! Genesis, XXXVII, 19. |