OUR SEROTHERAPEUTIC MEASURES.
Authors: H. T. RICKETTS
Journal: JAMA (1904)

to toss and roll in a broken, dreamy and unsatisfactory few hours' sleep !Will we give him his sleeping potion, gradually increased, until he becomes a complete wreck and finally lands in an asylum or commits suicide ?How about the broker on the exchange?The man who works eighteen and twenty hours out of the twenty- four?The professional gambler?The man who is constantly using liquors to excess but not to intoxica¬ tion ?Shall we give these hypnotics ?At an hour when sleep is most needful, should we give a narcotic or hyp¬ notic to a crying child to induce sleep?Is it a case of earache, indigestion, too much or too little cover, fear, fever, night terrors, or some other condition?These are a few of the possible conditions that may be slighted and the hypnotic given as a matter of routine.We should never overlook the fact that a close, warm and poorly ventilated room is often the cause of in¬ somnia and disturbed sleep.It is a bad policy to sleep in a room with a burning light or gas jet, as a poor hypnotic effect is realized.The practice of inducing sleep by the inhalation of chloroform, ether and benzine can not be too strongly condemned.It is dangerous and injurious, and soon becomes a fixed habit.Hypnotic suggestion is often valuable.Gentle stroking massage of the forehead and neck will often induce sleep.Many persons will lie awake for hours, but if a cup of warm milk or bouillon is taken on retiring, Nature is soothed and sleep comes.Conversation, argument, games of chance, light reading and brain work should be avoided immediately preceding retiring, as these induce wake- fulness.Many patients come with the tale of no sleep even for one hour, for one, two and three weeks at a time.While it is unnecessary, inadvisable and useless to question their veracity and to argue with them, we should accept their statement cum grano salis, and be governed accordingly.Such patients find considerable broken rest every twenty-four hours (there may be an occasional exception), and instead of prescribing strong hypnotics, we should seek for the possible causes, treat them and be absolutely positive in assuring results.This class of invalids should never be deceived, for the least-discovered deception will prevent the accomplish¬ ment of good.Some will occasionally need hypnotics, while others will benefit from a placebo.Mild massage, warm baths and warm-oil rubs at bedtime are often good sleep producers.Many neurasthenics and overworked people drink a glass of beer or take a small drink of whiskey at bedtime to induce sleep.It works well in most cases, but as time passes the small drink has grown to be a glassful, and often one-quarter to one-half pint of whiskey.Sleep will not come without it.Such sleep is not restful, and the toxic effects of alcohol are produced next daynervousness, irritability, headache, poor appetite ' and often delusions.We must be careful how we order al¬ cohol as a hypnotic.It is a fine remedy in some cases, but a two-edged sword in others.It is so convenient as a remedy that some physicians fall into its use and very soon, to their discredit, its abuse.When a physi¬ cian reaches a constant state of insomnia he is a candi¬ date for a rest cure and change, and not a course of hypnotics-so with all business men.Two of my most prominent patients in Philadelphia, when under ex¬ treme stress of business cares, can not sleep at home, but come to Atlantic City in the evening and sleep in the soporific influence of the sea air as calmly as a healthy child, and arise next morning fresh and vigor¬ ous-not drug logged.One writer has aptly said : "In- somnia is the rich man's burden-sleep the poor man's blessing."The rich constantly live in the future-the poor for to-day-thus causing most cases of insomnia in the former.