A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 8).
- James Copland
- Date:
- 1834-59
Licence: Public Domain Mark
Credit: A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 8). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
![nervous and cerebro-spinal energies ; a plethoric state of the brain, or of the vascular system gen- erally ; the superabundance of excrementitious materials in the blood, or an imperfect oxydation of this fluid ; the administration of narcotizing substances ; and various related morbid affections, induce sleep, either excessive as respects, its con- tinuance, or of a disordered or unrefreshing kind (see art. Coma and Lethargy). 13. The accession of sleep is very different in different persons, or when sleep supervenes nat- urally and healthily, and when it is induced arti- ficially, or assumes more or less of a disordered character. Healthy sleep may occur either sud- denly or gradually. Disordered sleep is gener- ally slow and partial in its accession. The sen- sorium gradually loses its control over the cur- rent of the ideas, which becomes unconnected and incongruous ; and in this state of transition—of half sleeping and half waking—a dreamy, or even a delirious existence is passed for a longer or shorter period, until an entire loss of sensibility of external objects—a more complete torpor of the sensorial parts of the brain—supervenes, and sounder sleep is induced. The disposition to and indisposition from sleep are very much in the power of the individual, for, by abstracting the mind from all objects of sense, and from the suggestions or ideas they excite, by ceasing every phase or mode of volition, and by ceasing to think upon or respecting any topic requiring mental exertion, or calculated to occasion mental excite- ment, or by directing the attention to, and fixing it on, a single, uninteresting, unexciting, or sim- ple object, and engaging the thoughts with no other, the sensorium will soon lapse into that state of torpor productive of sleep. 14. The accession of sleep is often attended by various morbid phenomena, especially in per- sons predisposed or subject to any nervous, or spasmodic, or paralytic affection. These consist chiefly of startings, twitchings, contractions, or cramps of one or more limbs or muscles ; of con- vulsions and spasmodic laryngeal disorders, or croup, in children; of epileptic fits, more or less complete, or merely slight or partial, and even of various mental and spectral illusions. Any of the foregoing may occur upon the accession of sleep, and before sleep has become complete, or immediately upon falling asleep; or during the commencement of sleep, when sensation is par- tially or suddenly excited by any excitant or dis- turbing cause. 15. Awakening from sleep may be either sud- den or gradual. The healthy and sufficiently sound and prolonged sleep terminates spontane- ously and immediately, leaving the person who has enjoyed it refreshed and active ; or if it be terminated by impressions made upon the senses, these impressions produce this effect readily and completely — an effect not observed from them when the sleep is of that morbid kind which con- stitutes lethargy, stupor, sopor, or coma, in its several morbid grades. Disordered, unsound, or insufficient sleep generally passes into that state of half sleeping and waking noticed above ($ 4), and, according to the circumstances causing the disorder or unsoundness, is attended by the dreamy, or even by the delirious states of tempo- rary existence just mentioned, until stronger im- pressions on the organs of sense, or diminished torpor of the sensorium — the increased activity of the sensorial or conscious portions of the brain —are followed by the restoration of the several manifestations or functions of this organ. 16 Sleep maybe excessive: 1st. As respects its duration ; 2d. As regards its profound char- acter, and the difficulty of arousing the person from it; and, 3d. In the frequency of its recur- rence These arc diseased states, and either amount to one or other of those described under the heads Coma and Lethargy, or generally pass into one or other of them, if not soon arrested by a treatment appropriate to the exciting and patho- logical causes which occasion them. Too pro- found or prolonged sleep should always excite suspicions of a disposition to, or the actual pres- ence of, cerebral congestion, owing either to nervous exhaustion, or to a morbid state of the cerebral circulation, or to an interrupted return of blood from the brain, occasioned by pulmonary or cardiac engorgements, or to a morbid state of the blood itself. To one or other of these morbid conditions, excessive or deep sleep, especially when amounting to lethargy or sopor, may be im- puted, the existence of either condition, or of more than one, generally becoming manifest upon a careful examination of the case.* 17. II. Sleeplessness — Wakefulness — [* A very remarkable case (Cataphora of Good) was exhibited in the city of New York, in the summer of 1853, in the person of a man named Cornelius Vroman, who was said to have slept five years, with intervals of wakefulness amounting to not more than three days in that time ; the longest period being sixteen hours. He lay like a person in ordinary sleep, the eyes nearly closed, but rolled upward, with a quivering of the eyelids, and resistance to opening them, with rigidity and fixedness of the muscles of the limbs, as in catalepsy, or artificial somnambulism; respiration rather slower than natural, breathing slightly stertorous, pulse some seventy-five strokes in the minute, soft and weak ; mouth slightly opened, with spasmodic contraction of the muscles on attempting to open it by force. The body was very much emaciated ; the arms folded upon the breast, and any at- tempt to remove them strongly resisted. The muscles generally were rigid and tense when the effort was made, and it was impossible, without violence, to change the position of the limbs. When placed erect on his feet, it required some moments to balance him exactly, but after- ward he retained the same position, as in catalepsy, and once for three days at a time. He was a farmer, from the town of Clarkson, New York. In June, 1848, he employed a physician for pain in the stomach and head, which grad- ually resulted in a disposition to sleep, until it was im- possible to wake him. Wakeful intervals of short dura- tion would occasionally occur, but of late once only in about six weeks ; and when awake, he seemed totally unconscious of his peculiarity. He then straightens him- self up, and walks as limberly as others. His diet has consisted chiefly of milk, which has to be administered by prying open his jaws as in trismus. Once he went without food for five days, during which there was no change in his symptoms. When the seizure commenced, his weight was 100 pounds ; in October, 1853, it was but 90. Height 6 feet 2 inches. Urinary secretion high col- oured, of about the normal quantity, and discharged once or twice a day, and not involuntarily. Alvine evacuations very scanty, occurring only at intervals of from six to twenty days. He had been subjected to various treat- ment, as bleeding, setons, issues, blisters, tonics, stimu- lants, <fec, but without any effect. We have called this a case of Lethargy, or Cataphora of Dr Good, of which he has given an example that con- tinued five years, in the person of a young lady eighteen years of age, whose mind had been previously in a state of great anxiety; the remissions recurred irregularly twice or three times a week, and rarely exceeded an hour or two ; during these periods she sighed, ate reluctantly what was offered to her, had occasional egestions, and instantly relapsed into sleep. In the case, however that we have related, were combined the symptoms of ecstasy ( total suspension of sensibility and voluntary motion i mostly of mental power; pulsation and breathing con- tinuing ; muscles rigid ; body erect and inflexible — Good), with the most prominent ones of catalepsy (the limbs and body yielding to and retaining any eiven Dosi- tion). The disease resulted fatally in November, 1853, having continued from the 19th of June, 1848.]](https://iiif.wellcomecollection.org/image/b21111066_0026.jp2/full/800%2C/0/default.jpg)
