_Insomnia in diseases of the liver._--Inasmuch as the majority of these diseases interfere with the formation and proper discharge of bile it is desirable to avoid, as far as possible, the use of opiates in the disturbances of sleep that are so commonly consequent upon disorder of the liver. Simple restlessness at night can usually be obviated by the ordinary treatment that is remedial of the disease by which it is caused. But it often happens that hypnotic remedies must also be employed. Hyoscyamus, belladonna, chloral hydrate, and compound spirit of ether, are frequently useful. Sometimes when the evacuations exhibit a deficiency of biliary coloring matter, a grain of opium, with a few grains of calomel, forms a very efficient hypnotic. Alcoholic soporifics are not well tolerated when the gastro-intestinal mucous membrane is diseased. Biliary colic demands treatment similar to that that is required in nephritic attacks. Warm baths, fomentations, and a broad belt of oiled silk around the body, are very grateful, and are favorable to the induction of sleep. A course of nitro-muriatic acid, internally and externally, is often useful when wakefulness is associated with torpidity of the liver.[53]
_Insomnia in gastro-intestinal diseases._--In acute inflammatory conditions of the stomach and bowels, sleep must be invited by the use of opiates. Bismuth and morphia, with hydrocyanic acid, are the favorite means of obtaining relief. Opium in solid form is sometimes preferable when a slowly developed and long continued impression is desired. Warm baths and hot poultices also give great relief.
In all chronic affections of the alimentary canal opiates must be used with great caution, for fear of the opium habit, unless the case be incurable. Cancer of the stomach requires their free use. The milder disorders should be managed largely with hygienic treatment. The diet should be so regulated as to prevent the liberation of gas in the intestines, for their distention in this way is fatal to refreshing sleep. A gentle aperient or a large injection of warm water, often proves itself decidedly soporific in such cases. Catarrhal conditions of the mucous membrane prohibit the entire class of alcoholic and ethereal soporifics. Nervous and atonic dyspepsias are often benefitted by the use of bitter beer, and by drachm doses of brandy or whisky largely diluted. These should be taken at mealtime, or with food at bedtime. A glass of hot water shortly before retiring is often useful.