Insomnia; and Other Disorders of Sleep

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deration of those greater disturbances of sleep which either serve to prevent its full development, or else to actually interrupt its course, rendering it incomplete and fragmentary, or even abolishing it altogether. But, inasmuch as the healthy brain, when associated with a healthy body, can only by an extraordinary effort of the will be kept awake beyond a certain period, and then only for a short time beyond the ordinary interval of wakefulness, it follows that the study of the usual causes of insomnia must be an investigation of m

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urses who would sit with a wakeful infant under a powerful gaslight till after midnight, and then would express their surprise that the baby persisted in gazing at the flame instead of going quietly to sleep. The inhabitants of Northern Europe find it necessary to darken their sleeping rooms during the long polar day; and travelers in such regions often suffer for want of the natural sleep which only darkness affords. Judge Caton, writing of his travels in Norway[28] says: "We longed for darkness and for

s cover their faces with the bed clothes for the purpose of excluding the light while attempting to sleep. Repose thus obtained in the daytime often serves to convert the night into a season of wakefulness. The Africans

the streets adjoining their houses. One of my acquaintances was awakened one night by a flash of light from the lantern of a burglar who was moving noiselessly about her chamber. The experience of al

mpressions upon the ear. Often in sleep it seems as if the sense of hearing remained wakeful and watchful for expected signals, as when an alarm clock serves to arouse the sleeper at an appointed hour. Sometimes the sleeper may be shaken and tumbled about in his bed without waking, but if he be addressed by name he

n full of people, when the wheels were suddenly stopped! A recent traveler in Guiana[30] relates a curious experience with an Indian magician who undertook to cure him of a slight headache and fever. The method of cure consisted in placing the patient at night in his hammock, while the magician kept up a hideous succession of yells and shouts, shaking the walls and roof of the house with an uproar which never ceased for six hours. Before long the patient passed into a

the various factories which spring up in their neighborhood. While it is seldom true that the vapors discharged by such establishments are directly deleterious to health, they may become indirectly a cause of ill-health through the wakefulness occasioned by them among weakly invalids. The smell of smoke in a bed-chamber so

me time irritating the nerves of common sensation about the mouth, that very little can be said regarding the matter. Dreams of gustatory sen

tant factors in the determination of sleep. A high temperature keeps every one awake-a fact well known among the unfortunate denizens of the garrets in our great cities. Not only is wakefulness the direct result of heat, but it is aggravated and embittered by the accompaniments of a torrid climate-insects, foul air, and cutaneous disorders. In the East Indies, so difficult is sleep under such conditions that the wealthy inhabitants compel their servants to cool them all night

order to find a climate sufficiently dry and cool to furnish the condition for refreshing sleep. For the same reason many of the inhabitants of the Southern United States are forced to spend the summer months in the invigorating atmosphere of Minnesota and Northern Michigan. One of the most delightful of experiences may be procured on any warm day in summer by embarking, at Chicago, upon one of the steamboats bound to Mackinac. At the wharf, in the hottest and dirtiest part of the city, all is dust, perspiration, and discomfort. The wide cabins are filled with people who are tired, thirsty, and discouraged. Sickly, squalling babies swarm in numbers sufficient to drive one mad. As the sun go

re than is usually known to these results. A cloudless sky gives evidence of positive electricity, which is much stronger in winter than in summer.[33] Clouds are sometimes positive and sometimes negative. According to Fonssagrives[34] the atmospheric electricity is positive during northerly winds, and negative during the prevalence of winds from the southerly quarters of the horizon. Great disturbances of the electrical condition of bodies is often observed during the occurrence of the sirocco in North Africa. Arago has related the case of an officer in the French army[35] who saw sparks of electricity leaping from his epaulettes at every blast of the siroc

. This is a pathological process, and, therefore, must not be mistaken for natural sleep. It may result either from cerebral congestion, or from cardiac exhaustion, and is characterized by an extraordinary bodily temperature and a high rate of mo

m. Local refrigeration of any portion of the body thus acts as a painful excitant of the cerebrum, and produces wakefulness, very much as distention of the intestines with gas will keep one awake. It is for this reason almost impossible to sleep with cold feet. Conditions of this sort are pathological, and are far in excess of the agreeable coolness which favors sleep. The effects of progressive diminution of the temperature of the air are well illustrated by the hibernation of animals.[38] As the temperature of the air diminishes, in winter, animals like the marmot fall into a species of sleep. Their movements of respiration and circulation are greatly reduced, and their bodily temperature falls, though it always remains several degrees above the temperature of the surrounding air. So long as the average de

rieties of eczema and psoriasis. The troublesome forms of pruritus which accompany icterus, or which may occur without any clearly defined cause, are frequent causes of wakefulness. The last mentioned disorder must, however, be sometimes recognized as a consequence of central nervous disorder, rather than a result of peripheral disease. Witness the frightful itching sometimes experienced during the progress of chronic myelitis. All kinds of injuries, wounds, ulcers, and other local inflammations are common causes of insomnia by reason of the painful impressions transmitted from them to the brain. Hence the great impor

c nerves play an active part. In certain portions of the body, as in the principal viscera, and in the periosteal covering of the bones, they are the interstitial nerves of the structures. When the body is in a healthy condition these nerves convey impulses of a sensory character which do not reach the cerebral organ of conscious sensation. But in certain morbid states they become inordinately sensitive, and they then serve to convey and probably also to magnify sensations to an extent that may cause exquisite pain with all its consequences. Witness the pain experienced during the various forms of colic. Rheumatic inflammations, pleurisy, pericarditis, peritonitis, cystitis, metritis, ovaritis, gastro-enteritis, and other similar diseases owe their principal suffering to the affection of the sympathetic nerves con

morbid states of the

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f excitement be too far prolonged, the nutrition of the nervous centres suffers, and the regulative apparatus of the cerebral circulation becomes exhausted, so that the brain cannot rest, because its inhibitory centres have lost their power of control over the lower ganglia of the organ. The cerebro-spinal centres are then in a condition analogous to that of a locomotiv

lity, till the patient becomes notably an?mic. In this condition the brain is inordinately excitable. It is incapable of sustained activity, and the patient may even be oppressed by an inclination to constant drowsiness; yet he will be unable to sleep soundly, and his sleep will be continually agitated by dreams. This state is one of the constant accompaniments of slow starvation. The molecular structure of the nervous organs seems to be so slightly constructed, under such circumstances, that its equilibrium is disturbed by the most trifling i

of the mind is due to excitement of the cerebral cells, accompanied by a lavish irrigation of their substance with the plasma of the blood. In the other case the excitement is occas

timulate molecular movement. Perception is thus quickened, and the mind is aroused. Sleep is postponed until the effect of the stimulant has subsided. This form of wakefulness is quite different from that produced by alcoholic drinks. These operate, when taken in small quantities, to favor cerebral equilibrium-and consequent equanimity-by producing

of meningitis, are causes of a wakefulness that persists until the brain is merged in the coma of compression. The interstitial changes which cause the various forms of insanity, are in like manner causes of wakefulness. Local injuries and degenerations of brain-sub

r with the air that enters the lungs. Thus wakefulness may accompany cutaneous disorders that interfere with perspiration. Imperfect elimination through the liver, kidneys and intestines, leaves the blood charged with excrementitious substances which arouse the brain to wakeful