We have mentioned in a previous chapter that insomnia is a source of great danger to our prospects for a continued youthfulness and a long life.

Before dealing fully with this subject it may be useful to refer to the treatment of sleepiness also, as our remarks concerning this will tend to explain better the novel and most rational treatment of insomnia which we here advocate.

We have already seen that the degeneration or removal of the thyroid gland produces sleepiness, and its hyperactivity sleeplessness, as in Graves’s disease. It therefore appears rational that if we wish to treat sleepiness we must first create a condition of hyperactivity in the thyroid gland, or at least we must improve its action.

The best way to attain this is to administer thyroid extracts, which, as we have stated before, are able, according to our researches, not only to improve sleepiness, but even to create the opposite condition—sleeplessness.

We have already referred in another part of this book to our observation of a case of sleeping sickness in an officer of the Belgian Congo Army, who was almost always asleep. To him we administered thyroid tablets, and after a few days there was a marked change in his mental attitude and in his whole condition, and the sleepiness improved. But we obtained still better results in the case of a very stout man weighing 124 kilos, who was always falling asleep, so much so that he was arrested in the picture gallery at Versailles, where he had fallen asleep while looking at the pictures. This patient would fall asleep when out walking, and this occurring in the streets of Carlsbad, he was picked up under the impression that he was drunk, while in reality he was perfectly sober. Having treated him for a few weeks with thyroid tablets, his sleepiness was much improved, so much so that he did not fall asleep in our waiting room, where formerly the other patients would prevent him from falling off his chair when sleeping. This gentleman was the patient of Professor Launois, of Paris, and on his return home after a six weeks’ treatment we found that he was cured of his sleepiness and had lost 16 kilos (35½ English pounds).

We were also able to observe, in our own person, the action of thyroid extracts; for, having for a few weeks taken two tablets daily (about 10 grains), we began to suffer from sleeplessness, and our rest did not again become natural until after we had discontinued the thyroid treatment. This was an experiment that we made for our own personal instruction, and judging from the results, we considered that they indicated the trial of thyroid extracts in cases of habitual sleepiness.

To treat insomnia we naturally must first endeavor to prevent it, to do which we must bear in mind the advice tendered in the chapter on the hygiene of sleep. The best means to insure good sleep is to partake of a light early supper, and to have a very dark and quiet room. It is decidedly unreasonable to resort to injurious drugs for sleeplessness, instead of darkening the window and transom to exclude the light, and sleeping in a room where no noise can penetrate.

Persons suffering from sleeplessness must, above all, lead a hygienic life; they must take exercise every day, walking or running in the open air, even in cold weather, so as to produce some fatigue before going to bed. Sitting the whole afternoon and living in an overheated room is absolutely inimical to sound sleep; but overexercise and excessive fatigue may also be as bad.

It is an excellent thing for persons, whose sleep is not as it should be, to drive in an automobile or carriage for an hour, at least, before going to bed, the former being preferable owing to the greater current of fresh air. We often notice children getting drowsy after being out in the pure open air; and in places which are situated at a certain height up a mountain, we often obtain excellent results in insomnia.

Many people sleep better after a warm (not hot) bath, lasting twenty minutes at least, just before going to bed; on the other hand, a cold bath might prove too stimulating and hinder sleep.

Some people experience difficulty in falling asleep; others easily do this, but awake soon, after four to five hours of sound sleep, and then cannot fall asleep again. A very dark and quiet room may overcome this perhaps, but a room into which light enters from the street or through the transom will never do so. When there has been no sleep for a whole night, and no sleep on the second night till after midnight, we may give a remedy to produce sleep, but not otherwise. In principle we are decidedly against the use of remedies to induce sleep, and we only permit such after two partially sleepless nights—when on the third night there is no sleep until midnight, or after a thoroughly sleepless night when there is also no sleep the following night till midnight.

We have already mentioned that the effects of one sleepless, or several partially sleepless, nights, may be compensated for by one thoroughly good night’s sleep. As through sleeplessness toxic products are, in all probability, retained in the body, certain hygienic rules must be observed after a sleepless night, thus, for instance, a cold room ought to be heated before we get up, for the effects of such a night are, according to our observations, felt more when we get up in a cold room than when we get up in a well-warmed one.

It will also be most beneficial to take a very hot, or even a Turkish or Russian, bath after a sleepless night, in order to eliminate toxic products by abundant perspiration. An electric light bath may give better results, using principally the blue rays, as such have a soothing effect upon the nervous system, besides creating a free sudorific action.

If all the hygienic rules above indicated are applied and fail, then the conditions are such that we may resort to sleeping remedies, adopting, however, the principle to try first the most innocuous, and especially such as the patient will not become addicted to the use of.

The principal object is to diminish the excitability of the brain, and bromide is one of the least dangerous remedies to obtain this result. We will therefore first try sodium bromide, say, 20 grains, in a glass of water. Valerian also can give good results, and is not a dangerous remedy. There is a German preparation, bromural, composed of bromide and valerian, which is a very mild sleeping mixture. Chloral is also an excellent drug for reducing the excitability of the brain, but it is not so harmless as the others. There has, of recent years, been introduced from Germany a preparation, isopral, made from chloral, and for which it is claimed that it is a mild sleeping mixture to the use of which people do not become addicted.

Such remedies may be prescribed when there is only a temporary sleeplessness and not one of habitual long standing. When sleeplessness is more inveterate and obstinate the above remedies will give no result, and then stronger drugs must be resorted to, such as veronal; but this must never be given in large doses, as it may produce in certain persons symptoms of intoxication if more than 1 gramme (15 grains) be taken. The principle of this remedy, which contains urea, is to produce a condition analogous to intoxication, by producing fatigue. None of these agents should be used otherwise than under the supervision of a physician.

Some of our patients complained of heaviness in the head after the use of veronal, while others approved of it and found that they could also sleep on the following night, even after only the one dose.

It would be most injurious to health to use these sleeping mixtures habitually, especially opium and morphine. We have mentioned here only a few with which we have experimented on ourselves or tried on patients in cases of necessity, as all such remedies may be injurious to the brain if taken often.

We feel inclined to attribute greater importance to a sleeping remedy which is based on physiological observations of sleep. As we have already stated, thyroid degeneration or removal produces sleepiness; we have, therefore, tried the serum of animals whose thyroid has been extirpated, and, as will be proved, we have had good results in each case.

Being struck by the similarity of the symptoms of diabetes to those of Graves’s disease, and as a logical consequence of our researches on the frequency of a hyperactivity of the thyroid in diabetes, we tried a remedy for this condition which has produced as good results as many authorities have obtained in their treatment of Graves’s disease. This is the serum of goats from which the thyroid has been removed, prepared according to the formula of the celebrated neurologist, Dr. Moebius, of Leipzig, who died recently. This remedy, named after its discoverer “anti-thyroidin Moebius,” has not only afforded us good results in the diminution of glycosuria, as we showed by a number of cases in the book that we published upon the origin of diabetes, but also, what is still more interesting to our present subject, every patient suffering from insomnia exhibited an improvement; in fact, there was not a single case which did not benefit by this treatment.^[334]

Following an automobile accident we suffered much from insomnia. We tried this remedy personally, and after doses of 5 grammes (75 grains) we were each time able to sleep for about eight hours, and felt refreshed afterward. We have found this remedy superior even to veronal, for the latter, when tried personally and afterward in patients, did not give the same effect as anti-thyroidin.

This remedy has, however, one great drawback, and that is the exorbitant cost; and it requires to be taken in considerable amounts, at least 45 to 70 grains at a dose, although in some patients a soothing result has been obtained from 20 grains three times a day.

This drug diminishes the excitability of the nervous system, and is, therefore, an excellent remedy for insomnia, for it depends on a physiological appreciation of our knowledge of the influence of the thyroid gland on sleep. We have lately published an article on the hypnotic effect of anti-thyroidin Moebius in the “Therapie der Gegenwart” of Berlin, November, 1907.

Instead of the anti-thyroidin Moebius—the extravagant price of which forbids its general use—we would recommend extirpating the thyroid gland of a goat, which is a very simple operation, and making use of the milk, following the example of Professor Lanz, of Amsterdam, and of Walter Edmunds in London.

Our observations on the great influence of anti-thyroidin on sleep were confirmed by Professor Lanz in a discussion following an address we delivered before the Society for the Advancement of the Medical and Natural Sciences, in Amsterdam, on the 15th of March, 1905.^[335] He also mentioned the case of a dog whose master, a peasant, was tending the professor’s goats, whose thyroids had been removed and whose milk was being administered by the professor to his patients suffering from Graves’s disease. The peasant was told to give the goats’ milk to his dog, but after a time, the peasant refused to do this, as since the goats’ milk had been given to the dog, he always wanted to go to sleep, even when accompanying his master in his walks.