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.)
![gent occurrence of want of sleep in chronic dis- eases, as it is very generally observed and readily accounted for. 23. ii. Complete sleeplessness is often a most important symptom of disease, and when it oc- curs without any manifest physical disorder to account for its existence, it should be viewed as the forerunner of dangerous disease, particularly of the brain. Complete wakefulness, even for many nights, is generally attendant upon nervous and other fevers of a continued type, upon in- flammations of the brain, and upon inflammatory affections of an acute character. It also attends the eruptive fevers, rheumatic fevers, delirium tremens, the gouty paroxysm, painful and spas- modic maladies, and pestilential distempers. When it is continued for many nights and days, vital power and resistance become exhausted, and delirium, followed by coma, is very apt to supervene. All acute diseases attended by feb- rile excitement or increased vascular action, espe- cially towards or during the night, are charac- terized by a more or less complete insomnia; and when the febrile action subsides, then sleep returns, the occurrence of sleep often proving critical of these diseases (see art. Crisis). 24. When insomnia is not followed by sound repose after a long continuance, it often passes into a state of half sleeping and half waking', in which the ideas of the patient are rapid, uncon- nected, and otherwise disordered, and generally expressed aloud, or in a low key. He dreams aloud in this half-conscious condition ; or be- comes more obviously delirious. The slighter forms of this delirium have usually been called wanderings of the mind, and at first they appear only occasionally, or during the night merely ; but, when they are not soon followed by composed sleep, are apt to be more continued, more fully de- veloped, and to pass ultimately into sopor or coma. 25. If wakefulness is unattended by any very manifest disorder, or even by slight disorder, or such as appears insufficient to account for it, some serious disease of the brain should be viewed as impending, although a considerable time may elapse before the advent of it. In these cases, the symptoms more especially connected with the nervous systems should be carefully investigated, in connexion with the occupation, habits, modes of living, arrangements for sleeping, ventilation, &c. The temperature of the head, action of the carotid arteries, the functions of sense, and those of digestion, assimilation, and excretion, ought to be carefully examined, and a treatment based on the report thereby obtained should be adopted. A dignitary of the Church consulted me for pro- longed insomnia. He evinced no other disorder. Palsy, or apoplexy, or coma was dreaded, and the treatment was directed accordingly. He was soon very much better, and continued so for two or three years, during which time I did not see him; but at the termination of it he was seized with apoplexy, at a great distance from London, and died in a few hours. An eminent physician and author was afflicted with insomnia, he after- ward became insane. A patient to whom I was called had long been subject to wakefulness, and was afterward attacked with phrenitis. [There is a form of sleeplessness which is often the precursor of insanity. Sometimes, perhaps generally, it is accompanied by the well-known symptoms of incipient mental derangement, and, unless it is relieved, confirmed insanity is very sure to follow. Diligent inquiry should in all cases be made as to its causes, and *c mj ef- fectual and prompt measures resorted to.tor their removal. An aperient, followed by a full dose Of a suitable narcotic, repeated according to cir- cumstances, will often succeed in overcoming the watchfulness.] 26 Pervigilium is not infrequent in nervous females, after their confinements, especially when they breathe a close or impure air, or when they have experienced hemorrhagic or exhausting dis- charges It may pass gradually, or even sud- denly, into delirium or mania, if not arrested by an appropriate method of cure. I have been called to several cases of this kind, where the disorder was aggravated by a treatment diametrically op- posite to what ought to have been adopted, and which, when adopted, speedily cured the patient. This is a most important affection in the puer- peral state, and should, even when attended by no other manifest disorder, receive constant atten- tion, and suggest the most decided and appro- priate means of cure—appropriate, however, to the various circumstances which occasion it, to the several associations in which it is presented to us, and to the maladies of which it is either the precursor or the attendant. 27. Insomnia is sometimes met with in young and even in older children: in them it should be viewed either as the precursor of serious disease, or as caused by some latent or undeveloped mor- bid condition. It not infrequently precedes or attends disease of the membranes or substance of the brain, especially tubercular deposits in the former, or softening of the latter, before serous effusions take place to any considerable amount; or it accompanies the earlier and more latent stages of these lesions. 28. iii. The treatment of insomnia should be altogether based upon those indications of cure which the disease of which insomnia is sympto- matic, or of which it is the precursor, should ra- tionally suggest. It is owing chiefly to a neglect of this principle that means, directed more par- ticularly to this symptom, either fail of producing their intended effects, or even often greatly ag- gravate this particular disorder. In all cases of insomnia, attention should be directed to the age, temperament, habit of body, modes of life, and diathesis or morbid tendencies of the patient, be- fore measures should be prescribed for the disor- der, and these measures ought to be especially devised against the disease on which the wake- fulness depends. A principal indication is to re- move the several causes, remote, external, phys- ical, and pathological, which occasion it, more particularly to correct a close or contaminated air ; to reduce the temperature of the apartment when it is high, and the quantity or warmth of the bed-clothes; to remove all the excitants of the senses; to abstract the mind from all excit- ing, harassing, or engaging thoughts, and to di- rect it to such as are uninteresting or unexciting —to one simple, unimportant topic ; and to re- move or counteract the morbid conditions, of which this is a symptom or prominent conse- quence. In both young and aged subjects, but especially in the dyspeptic and gouty, the ac- cumulations of disordered secretions and excre- tions — of faecal or contaminating matters of flatus, of acid or saburral materials—or a loaded state of the stomach or bowels, are apt to take place, and require free evacuation and correction](https://iiif.wellcomecollection.org/image/b21111066_0028.jp2/full/800%2C/0/default.jpg)
