One of the most distressing forms of insomnia is occasioned by the different varieties of asthma. Dyspnœa is the feature that is common to them all, and is the principal exciting cause of wakefulness. In recent cases, which are characterized by spasm, the various anti-spasmodics are useful. Tincture of lobelia, tartar emetic, and ipecac, are of great service. Inhalations of ether or of chloroform, or of nitrite of amyl, will often cut short a paroxysm; but the nervous system soon becomes tolerant of their action. Chloral hydrate and alcoholic stimulants are less vigorous, and cannot be long tolerated by the stomach, especially if there be a gouty diathesis behind the disease. The fumes of burning pastiles containing nitre and stramonium leaves are often of great service if so breathed as to thoroughly fill the lungs with the smoke. In like manner, the smoke from smouldering nitre-paper, or from cigarettes that have been dipped in an arsenical solution, is sometimes useful. Air charged with ozone has been found curative in some inveterate cases. Hyoscyamus, belladonna, and tobacco, have been recommended. It may even become necessary to employ hypodermic injections of morphia.
If, however, the disease should resist all these anti-spasmodics and soporifics, besides the remedies addressed to the predisposing causes of the malady, the only thing that remains is a change of locality. Many very desperate cases have thus been restored to health and comfort.
_Insomnia in renal disease._--In the acute forms of renal disorder this is usually caused by pain and fever. It is, therefore, to be relieved with opiates given in connection with such arterial sedatives and diaphoretics as each individual case may require. But the tendency of inflammatory diseases of the kidney to merge in uræmia must not be forgotten, and the soporific must be used in such cases with great caution. For this reason hyoscyamus is often preferable to an opiate. In extreme dropsical conditions the measures that are useful for the reduction of anasarca constitute the most efficient means for the induction of sleep. In nephritic colic pain is too severe to admit of any rest while it lasts. The general treatment of colic is all that can occupy the attention until relief is secured. The dyspnœa and wakefulness sometimes experienced in advanced cases of Bright’s disease may be greatly relieved by the judicious use of morphia, very much as in the similar disorder occasioned by chronic diseases of the heart.