Sleeping sickness

“ In the history of modern pathology, this organization of research in respect of “sleeping-sickness” must hold an important place as the application of state effort on behalf of the advancement of science. ”

“ In a district, therefore, where sleeping sickness has to be treated, its diagnosis is a terribly complicated business because the significance of every attack of fever, of {84} every persistent headache, of every prolonged attack of sleeplessness, and of all rheumatic pains must be gauged with the help of the microscope. ”

“ He has noticed that the sleeping sickness is always at its worst beside the lake, and putting two and two together like a sensible man has reached the conclusion that the disease may be propagated in some way in the blood of these things. ”

“ Malta fever is often attended with a weariness from suffering with the various joint and nerve pains so that insomnia is often marked.
Even in trypanosomiasis insomnia may be present at first. Insomnia is also one of the early neurasthenic manifestations of pellagra.
Somnolence.—The disease in which this symptom is best known is sleeping sickness. The patient may go to sleep lying in the bright sunlight or in the midst of eating a morsel of food. These cases can [604] be easily aroused but quickly drop off to sleep afterwards. They often deny that they were asleep. ”

“ The first symptom is drowsiness, and the following days and weeks drift past in sleep. The sleep grows deeper and heavier until the sufferer has passed out into the unknown, to the sleep that knows no waking.
Sleeping-sickness, in a moral sense, is a common disease in the world. It is often as fatal to activity and character as the dread plague of Africa is to the body. The temperature of the heart falls, the soul sleep deepens, God is forgotten, Christ forsaken. (Text.)
(1777)
LETTER OF GOD
An incident is related of William Duncan, the “Apostle of Alaska”:
One day soon after Mr. ”

“ There is no circumstance to which the sufferers under this disease ought to pay more attention than to their sleep, for every irregularity in this particular, will increase the violence of the disease. It is almost always produced by sleeping too long, frequently by sleeping too sound, and generally after having lain long awake in the night. ”

“ Persons suffering from either functional or organic disease are peculiarly liable to sleeplessness. When inability to sleep persistently occurs, and cannot be traced to any perverted mode of life or nutrition, there is good reason for surmising that some latent malady gives rise to so truly a distressing condition. Under these circumstances, instead of making bad worse, by swallowing deadly sleeping drugs, a scientific physician should be without delay consulted. Functional disorders of the stomach, liver, and heart are often the primary source of otherwise unaccountable wakefulness. ”

“ Sleep is a physiological necessity and death results within a few days if it be denied. In the fast, due to slight brain congestion produced by excessive elimination in the prior stages, inability to slumber is sometimes present, but attention to the bath and to the ventilation of the sleeping apartment brings refreshing rest as disease departs. No garment worn during the day should cover the body in sleep, and bedclothing should be regulated to an accurate degree of protection, neither too heavy nor too light. ”

“ If ever a good supply of sleep is needful, whatever the quantum required may really be, I am sure it is in such circumstances.
But then it should be remembered, in abatement of all this, that the symptoms of disease, in all the three cases which I have alluded to, as occurring in the family with which I was [Pg 68] connected, were very much alike; whereas neither the mother nor the child had suffered, prior to the sickness, for want of sleep. Must we not, therefore, look for some other cause? ”

“ Food.—In a considerable number of cases of [Pg 64] insomnia, its cause lies in an irritable weakness of the nervous tissues. Exhausted by overwork, or debilitated by the loss of blood, or half-starved during the course of a long illness like typhoid fever, a condition of wakefulness may be established which will add to the dangers experienced by the patient. In this state there is great restlessness—the sufferer experiences no severe pain, but he cannot lie still. This form of sleepless agitation is often encountered during the later stages of exhausting diseases ”

“ Whatever may be the situation of the patient at the moment previous to the invasion of the disease, he is at that moment asleep, although the transition from the waking to the sleeping state may be so rapid as to be imperceptible. I will explain this part of the subject more fully by and by, at present we will assume the fact, and proceed to enumerate the symptoms. If the patient be in a profound sleep, he is generally alarmed with some disagreeable dream; he imagines that he is exposed to some danger, or pursued by some enemy [Pg 22] which he cannot avoid ”

“ According to this observer, the affection commonly called the “sleep-disease” (maladie du sommeil) is met with only among the negroes of the coast, and principally those of the Gaboon and of Congo, becoming more rare towards the north. The most prominent symptoms are an irresistible tendency to sleep, and a feeling of torpor and numbness. The patient does not complain of pain, and yet there is a general weakness of the limbs, the gait is tottering, the sensibility is perverted, and the hands imperfectly grasp the objects they attempt to seize. ”

“ Take, for example, the fever patient. Anyone who has watched beside a loved one slowly consuming, with the fever raging in his blood, will remember the sigh of relief that has gone up from physician and nurse when the patient falls into a natural sleep after the turn of things. During dreadful nights and anxious days we wait breathlessly for the “crisis”; we hang upon the physician’s word, scan his face for every fleeting expression, because we may be deceived by the disease, but his practiced eye should know. ”

“ Insomnia in various disorders of nutrition.—The wakefulness experienced by syphilitic patients is not peculiar to their cachexia. It is a result of blood disorder and impoverishment that is common among the victims of rheumatism, lithæmia, syphilis, malarial poisoning, cancerous dyscrasia, chronic toxæmia of every form, and ordinary anæmia. Imperfect blood supply deteriorates the nutrition of the brain, and renders it so excitable that sleep is interrupted so soon as the period of profound repose is past. ”

“ To attack insomnia as a disease instead of a symptom, is sure to result in discomfiture in the great majority of cases, and is in every instance unsound in principle. Once established, this condition of wakefulness tends to perpetuate itself; but this would be otherwise with an absolutely natural regimen. A man is wakeful at night because under his present physical condition he ought to be—just as in diarrhœa, the looseness is doing its work of cure. So with all symptoms. Pain has its office, and this is coming to be better understood; is already well known to thoughtful, well-informed people ”

“ The patient also suffered from severe cold perspirations, as well as from heat and irritation of the upper portion of the body, and from entire inability to sleep. A very remarkable feature in the case was, that notwithstanding this general sleeplessness, each fresh attack of the malady was preceded by a sound slumber of some hours duration, from which she appeared to be aroused by the return of the more active symptoms of the disorder. ”

“ The sleepiness is unlike that of Belladonna, Nux vomica, Sepia or Sulphur, occurring early in the evening and characterized by stretching and yawning. It is not profound, and when the mind is diverted the patient gets wide awake, but soon relapses unless conversation is continued. In bed, sleep is disturbed by troublesome dreams and frequent waking. Aggravations occur after retiring, ascending stairs, from deep inspiration, walking in bright sunlight, lying on right side, riding in cars, and when stooping or writing. ”

“ Many of us, even in sleep, are keenly sensitive to suffering, at least to chronic as distinguished from acute pain, to dull protracted pangs like those of rheumatism, ear-ache, or tooth-ache. A little sharper pain, and sleep becomes impossible. The sufferer is not only deprived of the respite that slumber should afford, but insomnia itself enhances his sensibility, besides adding a new and terrible torment of its own. ”

“ In other cases there is chilliness, a general feeling of headache, malaise, and prostration, with lack of appetite or nausea, gloomy forebodings, taciturnity, nervous excitability, and restlessness. That restlessness which in patients cognizant of the consequence of the bite often induces insomnia during incubation, now often shows itself in an inability to keep quiet or to remain in one position or place—the exact counterpart of the initial restless stage shown in the canine patient. The sleep is now even more broken and unrefreshing and disturbed by fearful dreams. ”

“ The moderated activity of the body requires only a diminished rate of repair to make good the waste of the tissues. Less sleep, therefore, is needed. But the liability of age to the incidence of arthritic diseases, rheumatism, and disorders of the heart, [Pg 114] blood vessels, digestive apparatus, and urinary organs, renders the period of decline particularly subject to those varieties of sleeplessness which depend upon such derangements of health. The nutrition of the brain suffers under such circumstances, and the substance of the organ becomes morbidly irritable. ”

“ Sleep may operate like an invasive disease, falling with unequal incidence upon the different structures that make up the mass of the brain, paralyzing one portion, while simply benumbing another, and even arousing to excessive activity a third. ”

“ Rocking the child to sleep, or feeding it during the night will cause sleeplessness. Teething, colic, or any pain will result in disturbed sleep. Nervous children are frequently poor sleepers.
In older children, some digestive disturbance is, as a rule, the cause. Chronic intestinal indigestion, worms, adenoid growths, enlarged tonsils, lack of fresh air in the bedroom, cold feet, may, however, be the cause. Overstudy in school, poor blood, poor nourishment are always accompanied by inability to sleep soundly. Too strenuous play, exciting stories read before bedtime, may cause sleeplessness. ”

“ Some observations of Hippocrates were: -"When sleep puts an end to delirium, it is a hopeful sign." -"When on a starvation diet, the patient should not be allowed to become fatigued." "Old men usually have less illness than young ones, but such as they have last, as a rule, till death." "Pleurisy, pneumonia, colds, sore throat, and headache are more likely to occur during winter seasons." "When one oversleeps, or fails to sleep, the condition suggests disease." ”

“ Have females such emissions in sleep? Does not perfect [24] sleep consist in a total suspension of the operations of the Mind? May not dreaming, in general, be consider’d as a Disorder of the Body, and justly attributed to some cause, which stimulates the Sensorium Commune, and prevents perfect rest? Do people that sleep after much fatigue, ever dream?
The vast oppression on the Breast, and immobility of the Body, which are always felt in this Disorder, probably arise from the quantity of Blood collected in the Lungs, Vena Cava, right Ventricle, and Auricle of the Heart ”

“ Finally, it must be observed that wakefulness may result from excitement of the brain by irritating substances transported through the blood from distant centers of disease in remote organs of the body, or derived from articles that have been absorbed with the food and drink, or 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 wakefulness. ”

“ Bullock’s theories.
From the scientific point of view, sleep is principally a question of elimination; one might almost dare to say that rest is not necessary to the human body in health; it is the accumulation of poison within it that puts it out of order. The heart needs no rest, because of several elaborate systems which ensure that all poisons are thrown out of the blood immediately. If you deliberately poison the blood, sleep or coma result; or in certain cases, convulsions. All of these may be regarded as more or less desperate efforts to eliminate. Sleep is a symptom of intoxication. ”

“ For example: disease is often produced by lack of sleep; hence it is of central importance to teach people how to sleep. Excluding organic disease in the causation of most cases of sleeplessness—for most people suffering from insomnia do not have organic disease—one can say this: Insomnia usually depends on something wrong in the patient's day. The state of the night depends on the state of the day. If the day has been free not merely from gross sin, but free from hygienic blunder, then the night will go somewhere nearly right. ”

“ Sleep induced what I have called debility from abstraction, [93] and thereby disposed the miasmata which floated in the blood, to act with such force upon the system as to destroy its equilibrium, and thus to excite a fever. The influence of sleep as a predisposing, and exciting cause was often assisted by the want of bed-clothes, suited to the midnight or morning coolness of the air.
8. Immoderate evacuations. The efficacy of moderate purging and bleeding in preventing the disease, led some people to use those remedies in an excess, which both predisposed to the disease, and excited it. ”