THE RESTORATIVE TREATMENT OF SLEEP- 
LESSNESS FROM BRAIN EXHAUSTION. 
BY BOARDMAN REED, M.D., 
OF ATLANTIC CITY, N. J., 
FORMERLY PHYSICIAN TO THE MERCER MEMORIAL HOUSE FOR INVALID 
WOMEN. 
[Reprinted from the Journal of the American Medical Association.] 
One of the lessons strongly impressed upon me by 
my experience in practice is that insomnia when due 
(as is most frequently the case) to brain exhaustion, 
is best cured by tonic or restorative treatment, rather 
than by narcotics. It has been a source of gratifi- 
cation, therefore, to see the same lesson strongly 
inculcated by Dr. W. G. Eggleston in The Journal 
for February 19. I desire to confirm emphatically 
all that he said in his paper. 
It has been alleged by somebody that man is the 
only animal that can be taught to sleep on an empty 
stomach. But when one is suffering from brain-fag this 
teaching may fail even in man. Unquestionably a 
lunch at bedtime is wholesome and conducive to 
sleep, especially in brain-workers who sup early and 
retire late. But the lunch should be simple. Indi- 
gestible food taken at bedtime may easily disturb the 
sleep. 
The cold plunge or sponge-bath is another excel- 
lent hypnotic and a rational one, since it at the same 
time diverts blood from the brain to the capillaries 
of the surface and invigorates the nervous system. 
At this health resort, where many of the broken 
down people of the United States sooner or later 
come as to a sort of Mecca for the afflicted, I see 
large numbers of persons whose chief complaint is 
that they cannot sleep. Most of them have taken 
bromides persistently and often without advantage 2 
except at first. When such patients come with de- 
finite instructions from their physicians to persevere 
with a course of some bromide mixture, I have always 
encouraged them to give the remedy a thorough trial, 
but when the cause of the insomnia has been, as it 
is in nine cases out of ten, some form of cerebrasthenia, 
the result has generally been disappointing, evren in 
this air, which js exceptionally bracing and predis- 
poses most persons to sleep. 
The cases of nervous break-down 
enough to have caused a compulsory vacation, from 
business and a sojourn here at tht seashore, fre- 
quently require medical treatment to reestablish the 
habit of sleeping, and thus enable the exhausted 
nerve centres to be rested reinvigoratedand no 
sedative or narcotic drug -yet tried by me, whether 
opium, chloral, the bromides, hyoscyamous, hypscine 
or paraldehyde has provpd satisfactory in such cases. 
The tonic effect of the spa air with good food, mod- 
erate exercise and cheerful company often proves 
sufficient. When it doqs not, a light lunch'at bed- 
time with occasionally a'few teaspoonsful of whisky 
in milk added and the sponging of the'b'ody with sea- 
water followed by a thorough rubbing with i Turkish 
towel are highly useful-measures. But isorpetimes 
these all fail, and when tfiey do, my experience<eaches 
that to begin administeriftg any narcotic medicine is 
usually a mistake. My rpost frequent recourse now 
is to give some one of the nutrient nerve tonics, such 
as the compound syrup or glycerite of the hypophos- 
phites-a teaspoonful two or three times a day-or 
in some cases the compound syrup of the phosphates, 
commonly known, in Philadelphia at least, as Par- 
ish's Chemical Food. When the patient has a weak 
heart and insomnia results from a passive congestion 
of the brain, a condition frequently met with among 
neurasthenics, a little digitalis may work wonders and 
may usually be advantageously combined with very 
small doses of strychnia and quinine as well as with 3 
moderate doses of iron when this is otherwise in- 
dicated. 
Of course it goes without saying that bad sleepers 
should have their stomachs and livers put in as good 
order as possible, and when kidney or other organic 
disease has a causative influence, it demands the 
chief attention. 
There will remain, then, a certain proportion of 
cases in which drug treatment of all kinds has been 
tried and failed, and continues to fail even when tried 
again under the better conditions existing with rest 
and good hygiene in this invigorating seaside climate. 
When such patients fail to sleep and are driven 
almost insane for want of sleep, it is impossible to 
deny them a trial with narcotics. Yet I have seen 
an overtaxed journalist take astonishing doses of 
morphia besides really dangerous amounts of chloral 
and hydro-bromate of hyoscine without getting more 
than an hour or two of sleep and then sleep soundly 
after one or two treatments by the continued galvanic 
current, from eight to fifteen cells, passed directly 
through the brain. This was an exceptional case, 
but it is a constant experience with me to see elec- 
tricity in some of its forms prove of the utmost value 
in cases of insomnia as well as in all the other forms 
or manifestations bf nervous exhaustion. Massage 
is another promising auxiliary. 
If these few hastily recorded results of a consid- 
erable experience with insomnia serve to help phy- 
sicians who are not satisfied with the effects of the 
so-called hypnotic drugs, my object will have been 
achieved. Nerve tonics are often the best hypnotics. 
At my last visit, this evening, a puerperal woman who 
had been sleeping badly, said to me, "You put some 
quieting medicine in that last mixture." It was 
simply compound syrup of the phosphates. 
Atlantic City, N. J., March i, 1887.