Electricity may be used in many ways. The writer employs a weak constant current of 5 cells of a Leclanche battery, with one electrode on the forehead and the other on the occiput for 5, i o or 15 minutes. The interrupted current to the spine, alone or in conjunction with massage, has been used in some cases with satisfaction, and Faradisation of the head has often proved useful.
Static electricity gives best results. After insulation of the patient upon a glass stool, his body is brought into connection with the conductor of a Carr. or I toltz machine, and when thoroughly electrified a fine metal point is held opposite several spots on the scalp and forehead not near enough to produce a spark. The sensation is as it a light wind or breeze was pleasantly playing over the region, and McClure has found sleep come on whilst this form of electric souffle was being employed. The production of heavy sparks is not necessary or advisable, hut the use of the metal cap and static insulation gives the best results which can be obtained from electricity. The high-frequency current is less satisfactory.
1 )rugs must be employed when the above-mentioned remedies fail, and there is little danger of the formation of a drug habit if the narcotic be only employed for short periods in order to break the habit of lying awake, especially in cases where the insomnia has been of recent development.
Alcohol is of great value when used with caution and discretion in tem porary insomnia. The various spirituous beverages have very different therapeutic actions, which cannot be CN plained by their alcoholic strengths. Thus for insomnia wines are inferior to whiskey, and brandy does not produce as good results as whiskey. Strong ale is highly hypnotic, and so is porter or stout. To obtain the best hypnotic effect from alcohol, it should be given in one full dose just as the patient has undressed and lain down in bed. It acts more certainly if given warm, hut not hot. One wineglassful of good whiskey, made into punch, and swallowed as a draught —not sipped in spoonfuls--is a most invaluable soporific. Where the physician has reason to dread the formation of the alcohol habit it may be mixed with a bitter, or may be forbidden altogether after a short time. The danger of intemperance is much greater when alcohol is ordered to be taken with meals; hut this danger, when the drug is used in simple insomnia, should never he lost sight of. It is. surprising to notice, when the patient abstains from the use of alcohol at all other times, how the same dose may continue to produce its beneficial hypnotic effects without requiring augmentation for long periods. Headache and malaise seldom
follow, and when they do they may he prevented by using a more matured spirit. The product of the patent or silent still should be condemned; the writer has satisfied himself that it is more liable to lead to the alcohol habit than a mature pot-still whiskey, especially if swallowed in con centrated form.
Opium or Morphia is the most certain in its action of all sleep producers. It possesses the power of relieving pain by preventing the conduction or perception of painful' impressions, and sometimes this can be done by employing small closes which would have no soporific effect in ordinary states. As sleeplessness is so often caused by pain in the innumerable diseases coming constantly under the notice of the physician, it must be used often to induce sleep as in neuralgia, sciatica, pleurisy, cancer, angina, &c. In simple chronic insomnia, whether produced by mental overwork or occurring in the insane, and when not caused by or complicated with pain, opium or its alkaloids should not as a rule be employed.
Where the insomnia is of very short duration, and caused by mental worry or overwork, which is not at all likely to be repeated or become a habit—in short, where the cause is fleeting, or has already fled—opium is an invaluable hypnotic, and may be employed in such a case with great advantage. The dose should be a full one, 13 or 2 grs. of opium, or 35 mins. of the solution of morphine. The dose should be given as the patient lies down, and darkness and quiet should he maintained. If sleep does not result in two, three, or four hours, the same quantity may be again administered.
When morphia is administered hypodermically as an hypnotic for the first time a dose of alcohol may be given a few minutes before it, or i min. of Solution of Atropine should be injected along with it. When severe pain is present larger doses of opium are required, and it is as a rule better in such cases to repeat the dose at a shorter interval than to give one very large dose. In chronic bronchitis with profuse secretion, in the late stage of phthisis, in congested states of the brain with contracted pupils, in renal affections and in all ailments of childhood or infancy, opium is contra-indicated. In the insomnia of delirium tremens it may be given in large doses. In the painful insomnia of cardiac distress hypodermic injections of morphia ( gr.) often give great relief and sound sleep when every other hypnotic has failed, hut Paraldehyde should always be tried first.