Insomnia : its causes and treatment / by E. Mansel Sympson.

  • Sympson, Edward Mansel, 1860-1921.
Date:
[1889?]
Catalogue details

Licence: Public Domain Mark

Credit: Insomnia : its causes and treatment / by E. Mansel Sympson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    2/8 page 152
    sleep broken by restlessness, excitement, or active delirium. For instance, in a man who had right hemiplegia with temporary motor aphasia—due probably to arterial thrombosis—this was very marked. And in a woman, also hemiplegic on her right side, and permanently aphasic, this condition of sleeplessness and wandering continued off and on for some months. One of these cases may have been syphilitic, and syphilis is known to produce delirium. Whether it does so apart from the soften- ing of the brain which follows thrombosis, or from the damage wrought by gummatous tumours, I cannot say. In tumours of the brain sleeplessness caused by delirium is far from rare. In a case of cerebellar tumour, for example, the boy would continually turn over in bed, and wake up with a sharp scream. In a case of cerebral abscess restlessness and wan- dering were noticeable. In meningitis this state of delirious wakefulness is constantly seen, but the pain in the head is partly responsible for keeping the child awake, even when there seems to be no delirium. Of the insomnia of acute mania, with or without delirium, I have no clinical experience. Closely allied to these cerebral diseases—sometimes so like them that diagnosis is well nigh impossible for a day or two—is the insomnia and delirium of pyrexia. Besides the effect of the specific poison of scarlatina, typhoid, and the other acute fevers, there is a general irritant to the brain in the presence of over-hot blood, which produces delirium. Now this delirium and accom- panying insomnia may occur whenever the temperature is a degree or two (ioo° and upwards) above the normal, and the younger the child or the more exhausted the patient, the more enduring will be the delirium. In the sharp febrile attacks of acute pneumonia, to which children are very liable, the occur- rence of delirium is almost a certainty, and, in the interest of the patient's strength, requires careful treatment. Sleeplessness in phthisis, not dependent on coughing or on the profuse sweating, is common enough : probably the fever is the cause thereof. Again, overwork and worry—when the mind, like a caged animal, is perpetually going over certain events or lines of thought—these are very familiar causes of insomnia. Partly, no doubt, they depend on too great a blood-supply being kept up, but surely the mere cerebral activity demands that full blood- supply. Nothing makes a patient break down more readily than continued anxiety and sleeplessness. Even in the time of Aretaeus this was recognised. Insomnolency, he remarks, induces dyspepsia, atrophy, and wearies out the body; the spirits flag, and the understanding is unsettled; and for these
    digitised image 1
    digitised image 2
    digitised image 3