GENUS I. AGRYPNIA. Sleeplessness. DIFFICULTY OR INABILITY OF OBTAINING SLEEP. GEN. I. Origin of generic term not noticed by Cullen but generally by his predecessors. AGRYPNIA (άYgUzvía) is a Greek term significant of the English SLEEPLESSNESS, by which it is here rendered. The affection is not introduced into Dr. Cullen's nosological arrangement, and has consequently been omitted. by most nosological writers since his time; but it occurs in the greater number of those who preceded him; and its claim to be considered as an idiopathic affection, is as clear as that of most discases concerning which there is no dispute. The two following species are embraced by this genus: 1. AGRYPNIA EXCITATA. IRRITATIVE WAKEFULNESS. GEN. I. SPEC. I. SLEEP SPECIES I. AGRYPNIA EXCITATA. Irritative Wakefulness. RETARDED BY MENTAL EXCITEMENT: LIST- ON the physiology of sleep and dreaming, we briefly touched under the genus PARONIRIA or SLEEP-DISTURB GEN. I. SPEC. I. wakefulness. ANCE in the first order of the present class, but the subject is of great extent and complexity, and cannot be fol- Agrypnia lowed up into any detailed explanation in a work on pa- excitata. thology. At present, therefore, I can only observe that Irritative natural sleep is a natural torpitude of the voluntary or- Natural gans of the animal frame, produced by a general exhaus- sleep what, tion of sensorial power in consequence of an exposure to the common stimulants or exertions of the day. And hence, if such exhaustion do not take place, natural sleep cannot possibly ensue, though morbid sleep undoubtedly may as produced by other causes. and how produced. Now it often happens that, from an energetic bent of How the mind to a particular subject, the sensorial power con- prevented. tinues to be secreted not only in a more than usual quantity, but for a more than usual term of time; and, in consequence of this additional supply, there is no exhaustion at the ordinary period, and therefore no sleep. Severe grief is often a stimulus of this kind; during which a morbid redundancy of sensorial power continues to be secreted, followed by a morbid excitement of the system. generally from day to day, and from night to night, till the frame is worn out by the protracted watchfulness or sensorial erethism. And it is astonishing to witness in various instances how long the frame will support itself before it is worn out, or the irritation that prevents sleep Singular sufficiently subsides for its return, and particularly where examples the mind is labouring under the influence of the depress- ed sleeping passions, or of depressing pain. A hemicrania has kept a person awake for three months*; and a melancholy or gloom on the spirits, for fourteen months. Overwhelming joy has often a similar effect though seldom in an equal degree, or for so long a period of time. The mind may also be intensely directed to some peculiar object of study, and the energy of the will becomes in this case a like stimulus to the secretion of a fresh or protracted tide of sensorial power, so that the usual exhaustion of the nervous system does not take place at the accustomed * Bartholin. Hist. Anat. Cent. 1. Hist. 6. Schenck, Lib. 1. Obs. 256. of protract lessness. GEN. I. SPEC. I. Agrypnia excitata. Irritative wakefulness. period. This is peculiarly the case in a pursuit of the abstract sciences, or those of a more strictly intellectual nature, as the higher branches of the mathematics. Where the determination of the mind to a particular subject is exquisitely intense, whether that subject be a passion or a problem, by far the greater part of the sensorial secretion is expended at this particular outlet; and, consequently, the frame at large, with the exception of those organs to which such outlet peculiarly appertains, Occasional is so far drawn upon, as a common bank, for a contribuapproximation of sensorial power, that it labours under a certain degree of deficiency, and hence a certain degree of torpitude, so as to become insensible to the world around it; making, in this respect, an approach to the state of mind we have already described under the name of APHELXIA intenta, or mental ABSTRACTION. tion to aphelxia intenta, or mental abstraction. Medical treatment. The cure of this species of sleeplessness is to be accomplished by allaying the mental excitement by which it is produced. This is best done by recalling the mind from the pursuit that leads it astray, and a free surrender of the will to listlessness and quiet. The perturbation will then subside; the sensorial organs become tranquillized and inactive; the secreted tide of sensorial power will be at its ebb, and the habit of refreshing slumber resume its influence. But where this cannot be obtained by the mere exercise of the will, we must call opium or some other narcotic to our aid, which, by its revellent stimulus, may coincide with the consent of the will, and produce the exhaustion, and, consequently, the quiet that is requisite for sleep. SPECIES II. AGRYPNIA PERTESA. Chronic Wakefulness. 3LEEP RETARDED BY BODILY DISQUIET; ATTENTION ALIVE TO SURROUNDING OBJECTS. GEN. I. SPEC. II. THE exhaustion in which the very essence of natural sleep consists supposes a perfect quiescence and inactivity Causes. of the sensorial powers. Uneasiness of any kind will become an obstacle; and hence, an aching coldness of the extremities or of any other part will prevent it; an uneasy sensation at the stomach or any other part will prevent it; an absence of the common pleasureable feeling with which we ordinarily prepare ourselves for sleep will prevent it: "And, on this account," as Darwin observes, "if those, who are accustomed to wine at night, take tea instead, they cannot sleep. And the same evil happens from a want of solid food for supper to those who are accustomed to use it; as, in these cases, there is an irksome or dissatisfied feeling in the stomach. And hence, also, too great an anxiety or desire to sleep, is another cause of its suspension; for this as a mental disquiet will only add to the corporeal disquiet which has produced it; and, as already observed, the emotions of the mind must be as quiescent as those of the body, and the will, instead of commanding or interfering, must tranquilly resign itself to the general intention. Where uneasinesses of this kind has been permitted How conto continue for several nights in succession, the sleepless- verted into ness is apt to become chronic and to be converted into a wakefulness, habit. We have hence had examples, as noticed with for very long periods: GEN. I. SPEC. II. Agrypnia their appropriate references in the volume of Nosology, in which vigilance or sleeplessness has continued for a month without intermission*; for six months +; and even wakefulness. for three years ‡. pertæsa. Chronic for the whole life. Medical treatment. Habitual indulgencies. Soothing music, and agreeable reading. Hop-bags. Mr. Gooch gives us a singular case of a man who never slept, and yet enjoyed a very good state of health till his death, which happened in the seventy-third year of his age. He had a kind of dozing for about a quarter of an hour once a day, but even that was not sound, though it was all the slumber he was ever known to take S. The cure of this disease demands a particular attention to its cause; for if we can get rid of the organic disquiet on which it depends, we shall be pretty sure to succeed in obtaining our object. All irksome chills, and especially those of the feet, should be taken off by a sufficient warmth of clothing; and the habitual supper, or other indulgence which has hitherto preceded and introduced sleep, should be freely allowed. The lulling sounds of soft and agreeable music, or agreeable reading, have been tried as concomitants, and not unfrequently with success. And narcotic aromas have at times been had recourse to, especially that of the hop, heaped into pillows; but so far as I have seen, and I have once or twice witnessed the experiment, with as little ef ficacy, as the pillows of the male fern in cases of rickets, which were once, according to Van Swieten, in equal Pediluvium. estimation for this last complaint. A pediluvium as re Gentle friction. commended by Lang ||, will often be found a much better prescription, or any means which will excite that breathing moisture, which is indicative of general ease. Soft, gentle, and general friction, and especially where there is any chill or rigidity upon the limbs, will frequently produce the same effect in a very agrecable way: and this, too, Grüling, Cent. iv. Obs. 90. + Panarol, Pentecost. v. Obs. 4. § Medical and Chirurgical Observations, &c. 8vo. Epist. XLV. |