Part 4

In the toxic kinds of insomnia we must especially endeavour, as I have already suggested to you, to act upon the maxim, “_Cessante causâ cessat et effectus._” We must stop or lessen the consumption of tobacco, alcohol, tea, etc., as the case may be. The sufferer from toxic insomnia will ask you what must be done for sleep. This is not quite the question; the question is not what the patient must do, but rather what the patient must not do. The consumption of something must be left off. When you have found out the what and when of that something, the patient’s self-control, loyal coöperation, and obedience to your directions are essential to your curing the case. A discussion of the treatment of gouty insomnia, and of the sleeplessness arising in some chronic kidney diseases, would involve a consideration of the whole question of the therapeutics of the maladies upon which these forms of wakefulness depend. If you find evidence of copræmia in a case of insomnia, you must, in any case, treat the underlying fæcal retention. Such fæcal retention may be the whole cause, or an active part of the cause, of the insomnia. Senile insomnia is very obstinate. Perhaps in the bromides, with full doses of hop or henbane, we have the most efficient and least harmful medicinal means of relief; while the promotion of sleep may be accomplished by an intelligent combination of some of the non-medicinal measures to which I have referred.

Now I must close our consideration of this interesting subject of the therapeutics of intrinsic insomnia. I have sketched broad outlines for your guidance, which will suggest to you many other details in your practice. That the best physician is the physician who is the best inspirer of hope, Coleridge it was, I think, who so declared. He was largely right. Of course, truthful hope. Certainly is this largely true in nervous maladies. In the cure of intrinsic insomnia, especially, the best physician is one who is a master of his art and withal the most ingenious inspirer of his patient’s desire of cure and belief that it is obtainable.

FOOTNOTES:

[8] A Clinical Lecture: published in _The British Medical Journal_, December 8th, 1900; since revised and extended.

[9] Lectures on Pharmacology. New Sydenham Society’s Translation.

[10] A Text-Book of Pharmacology, &c.

[11] Siris: ... concerning the virtues of Tar water. By the Right Rev. Dr. George Berkeley, &c., 2nd Edition. Dublin, 1744.

[12] Elements of Materia Medica.

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Transcriber’s Notes:

Footnotes have been moved to the end of each chapter and relabeled consecutively through the document.

Punctuation has been made consistent.

Obvious typographical errors have been corrected.