INSTRUMENTS LEFT IN THE PERITONEAL CAVITY: AN ANALYSIS OF 44 UNPUBLISHED CASES
Authors: C. White
Journal: BMJ (1923)

AIn a case of insomnia our procedure may be simple enougl but it may, on the.other hand, involve much patience and tlh exercise of considerable self-confidence and analytical power: of no mean degree.In tlle light of present-day knowledge we may assume tlhal the area of conflict and unrest is in tlle cerebral nerve centres Wlhen these centres are unst',able through inherited defect: we must regard the case as capable of only partial relief wlhetlher our remnedies be psychological, plhysical, or cllemicalWe may discover that a hypersensitive condition of th4 cortex lhas been brought about by fatigue, arterio-sclerosis excessive or diminislhed blood pressure, toxins or excitants ol varfous kinds-alcohol, tea, coffee, etc.Here, of course, we try to remove tlle causes.In hligll blood pressure a lhot foot batli, or a wlhole body bath with or without mustard dissolved in it, gives considerable relief; mustard packs to tlle lowe: limbs and abdomen may draw the blood from the brain and give a good niglht's sleep; massage witlh brushing of tle body is also of use.In tlhese cases of hligh blood pressure the condition of the bowel must be carefully watclhed and constipation prevented.Suitable intestinal antiseptics may be' indicated.Whero the brain unrest is due tc psychic disturbances, suchl as a sense of loss, material or spiritual, fear, rage, hate, the treatment will depend on the severity of the case and its duration.Generally, a change of air and scene should be recommended before druas are given.A stago is reached -in a large number of cases of insomuia suclh as the foregoing in whidh no external treatment, no chaange of surroundings, will avail, 'and we find the patient going from bad to worse, often rapidly.It' is in suclh a case that the psyclhotlherapeutist is seeh at his best.If he is a stuident' of comparative' religions lhe may bring solace to tlie Roman Catholic by-nc'ura-ging him to repeat' certain formulas, by counting beads, and indulging in religious exercises tha-t have a strange -but -potent-sedative actioua Patients of the reformed faithi may find happiness in con- *templating the promises of the gospels, the fatherhood of God, and the brotherllood of mlan.Others, with or witlhout the religious sense, may find escape from the brain storms by reading books that amused or edified them in tlje lhappy days of their youth-a revisiting, as it were, of old intellectual pastures associated with the pleasantest period of life.It is always wise to reassure such cases.Many are really drifting towards the borderland of insanity, and we must try to arrest in them all sense of fear and despondency.In some cases we advise them to sit up late, play patience, or picture puzzles.Here is a remedy I lhave found useful: Get tlle patient to switchl on tlle light and carefully write down on a piece of paper the ideas disturbing hiim.This often succeeds in brealking up a-disturbing train of thought.Auto-suggestion in some cases is invaluable, and ljypnosis often breaks tlle vice-if it be not too long established.Maecenas had a plhysician, Musa, wlho, as a remedv for the