On the other hand, in acute disorders, and especially in abdominal complaints, sleeplessness with its immediate concomitants is a most valuable indication in the selection of the proper remedy.
We are not at this time to discuss the hygienic, physiologic and mechanic modes of treatment which have been suggested or which have secured professional approval, but simply to rehearse what has been accomplished by homoeopathic medication in overcoming the tendency to insomnia as we meet it in ordinary every day practice. And I am sure when we compare this with the acknowledged results of other modes of practice, we have no reason to be ashamed of the faith that is in us.
In the first place, there is that grand old remedy sulphur. Sulphur is as necessary to the homoeopathic practitioner as water; and according to our sarcastic but beloved opponent, Oliver Wendell Holmes, water is about all there is to homoeopathy. Now while sulphur is not quite a sine qua non, it would be exceedingly inconvenient to get along without it, and in many forms of chronic sleeplessness it will restore the equilibrium of an overwrought and unbalanced nervous system. Sleepiness by day, in the afternoon and after meals, followed by a restless and wakeful night, the short snatches of sleep which are obtained being burdened with anxious or frightful dreams, followed by late sleeping in the morning, and finally awaking tired and unrefreshed - these are characteristic of sulphur. No remedy in the materia medica contains in its pathogenesy stronger evidences of sleep disturbing power.
Allen gives nearly two hundred symptoms under this rubric, many of them most pronounced in character and power. Among these are:
Much yawning and sleepiness during the day.
Sleepiness in the daytime during the menses.
Excessive sleepiness during the day; he fell asleep as soon as he sat down.
Irresistible sleepiness during the day; she could not keep from sleeping while sitting at work.
Sleepless and wide awake all night.
Sleepless on account of excessive irritability and uneasiness.
Much too great wakefulness in the evening; the blood mounted to the head, and the night was sleepless.
She could not fall asleep before midnight, and then frequently woke and tossed about.
She fell asleep with difficulty and woke every hour at night.
She did not sleep a quarter of an hour at night, though she was weary.
Nights restless; he always woke, as with fright, from a fearful dream, and after waking was still occupied with anxious thoughts, as of ghosts, from which he could not free himself.
Restless sleep with constant dreams.
About 10 P. M. I went to bed but could not sleep before midnight; the sleep at length came on; it was disturbed by disagreeable dreams, and only became more tranquil towards morning.
Restless tossing to and fro at night.
He woke every night about 3 o'clock and could not fall asleep again.
Sleep disturbed; waking up at 4 A. M., and inability to fall asleep again, which had never before happened.
It is remarkable that from the commencement of this proving I have awakened every morning at 5 A. M., and have been unable to fall asleep again.
Frequent waking at night, with beating of blood in the head, then also in the chest.
She woke frequently from sound sleep without cause.
He woke every half hour at night, and could only sleep two hours towards morning.
Violent starting on falling asleep.
Contrary to usual habit, he was long in falling asleep, and when at last sleep came, it was disturbed by dreams of fire and death.
Such are some of the more evident of the sleep disturbing effects of sulphur. Into the mosaic of this picture may be fitted multiform conditions and symptoms; a sometime skin affection, an obscure rheumatic diathesis, an ill-cured or suppressed thoracic disorder, an unbalanced nervous system evincing itself by chorea, by epilepsy, by ill-defined warnings of an oncoming paralysis, or by some less serious symptom, such as burning in the soles of the feet, sensations of lassitude, weariness, and soreness. These and many other abnormal conditions and sensations may guide us to sulphur as the remedy homoeopathic to the case, but it is impossible in a brief article to more than touch the most salient features.
Sleepiness by day with sleeplessness at night is not especially characteristic of sulphur. Belladonna, sepia, pulsatilla, calcarea, phosphorus, china, arsenicum, carbo vegetabilis, ledum, kali carbonicum, baryta, causticum, magnesia carbonica, hepar, silicea, and probably forty other remedies have the same symptom. In fact none of the symptoms taken by themselves are determinative, and the prescription can only be based on the general aspects of the case.
Belladonna is best suited to cases of more recent origin, and where the causes of the insomnia are external and temporary, but it is of prime value in the sleeplessness succeedent to opium addiction, alcoholic inebriety, and other narcoses. Allen mentions about one hundred symptoms of which the most characteristic are:
Very restless sleep.
At night the boys became restless, spoke irrationally and could with difficulty be kept in bed.
Frequent starting as in affright, when just on the the point of falling asleep.
The child tosses about, kicks, and quarrels in its sleep.
Continual but ineffectual efforts to obtain sleep.
He is constantly awaked out of sleep by fearful dreams.
Belladonna is ordinarily useful when the the patient is sleepy, but cannot sleep; when, instead of natural slumber, he passes the night in that confused condition that he knows not whether he is asleep or awake; when, though conscious of his actual surroundings, he yet dreams, sees and hears objects not present, and is elevated or depressed by fantasies which he is quite aware are but the figments of his imagination. The day time symptoms are of similar significance. Confusion of the senses all day long, such as one feels after whirling around; dullness and stupidity, with incoherence of speech, as after a debauch; and these are worse when sitting quietly in his room, and are relieved by walking about and when going into the open air.
Hyoscyamus, while paralleling the the drowsy sleeplessness of belladonna, its frequent awakenings, its affrighted startings, its twitchings, groanings, and vivid imaginings, is yet perhaps more distinctively useful in that unwonted liveliness and excessive wakefulness which allies it to opium. To patients suffering from the disappointments of ambition, of love, or of business, hyoscyamus often brings relief, especially if these griefs awake a tendency to loquacity, to quarreling, to the use of indelicate language, to unseemly and immodest acts and gestures.
Stramonium is an invaluable remedy in the second stage of delirium tremens, and in all similar insomnic states, where in the interval between brief cat-naps, the patient indulges in ludicrous sayings, ridiculous gestures and droll imaginings.
Sepia is at many points in its pathogenesy analogous to sulphur and belladonna, and frequently in insomnia caused by hepatic and pelvic derangements it is a sovereign remedy. As in sulphur, there is the characteristic awaking at some specific hour in the early morning (say about 3 o'clock); there are the same restless nights and tired mornings, with sleepiness during the day; sleep does not refresh, but leaves a tired aching feeling all through the body. So closely do these two remedies resemble each other in the immediate concomitants of "sleep and dreams," that a differential prescription can alone be based on the moral and mental status evinced, and the conditions of aggravation and amelioration.
Pulsatilla is useful in the sleeplessness of indigestion, in insomnia from chloral addiction, from the excessive drinking of tea, and after the use of quinine, strychnine and iron.
Allen gives about fifty symptoms, the most characteristic of which are:
Sleep before midnight prevented by a fixed idea; for example, a melody constantly recurred to his mind, yet sleepiness prevented activity of memory and fantasies.
Could not fall asleep for a long time, then woke earlier than usual without being able to fall asleep again.
He is unable to fall asleep at night before 2 A. M.
Waking very frequently during the night and remaining awake; during the day sleepy.
Woke frequently on account of vivid dreams; for example, that he was falling.
Carroll Dunham says that the sleep symptoms of pulsatilla are a "great characteristic," and are "almost always present when pulsatilla is clearly indicated by other symptoms." When, therefore, a doubt rests on the selection of pulsatilla, it is safe to incline toward it if the sleep symptoms are: "Wide awake in the evening; does not want to go to bed; first sleep restless; sound sleep when it is time to get up; wakes languid and not refreshed."
Calcarea carbonica also has difficulty in getting to sleep, on account of many involuntary thoughts, and when asleep soon wakes up again; but this was preceded by great inclination to sleep in the evening, and is followed by difficulty in arousing in the morning. The sleep, such as it is, is disturbed by dreams, so vivid and frightful in their nature, that it seems impossible to free himself from their influence upon awaking. Calcarea is not likely to become a routine remedy in the treatment of sleeplessness, nor is it desirable that it should; but that it is often overlooked in cases to which it is the true homoeopathic similimum, is, I fear, too true. If some of our more "liberal" brethren, whose itching palms crave the ways and methods of "regular" medicine, would enlarge the borders of their work-a-day materia medica, they would perhaps find less use for the hypodermic syringe. And I venture to say, that rarely as calcarea is indicated in the treatment of insomnia, it is of ten times the value in the cure of this disorder to that dangerous little squirt-gun.
As regards the particular indications for calcarea, it will be found that in that condition of inertness and depression which finally passes into one of peevishness and nervous irritability, with hopelessness of ever being cured, and with the fear of impending death tormenting him day and night, this state of things having been brought about by digestive disorders, imperfect assimilation, and living in unwholesome and damp places, this remedy is capable, in the higher potencies, and with judicious infrequency of dose, of so altering the dyscrasia upon which all these untoward symptoms (including the sleeplessness) depend as to work a marvelous and enduring cure.
Phosphorus, arsenicum, carbo vegetabilis, ledum, kali carbonicum, baryta carbonica, hepar sulphuris, causticum, magnesia carbonica and silicea, though all of them rich in symptoms of disturbed sleep, must here be dismissed with a word. Their general characteristics are well known to all careful practitioners, and it is upon these, and not upon the symptom which they all possess in common with sulphur - sleepiness by day with sleeplessness by night - that the decision as to the expediency of their use must rest. With phosphorus, carbo vegetabilis and ledum, the sleeplessness is more pronounced in the earlier hours of night; while with arsenicum, kali carbonicum and silicea it is from midnight to morning.
Coffea is often indicated in the wide-awakeness of babies from dental irritation, dividing the field with chamomilla; but sleep in this latter is prevented by "cussed" irritability, while in the former the little patient just seems to have forgotten that there ever was any such thing as sleep. Coffea is useful mainly as a palliative, and soon wears out its effects. It can rarely be used successfully for more than two or three consecutive nights. But in those temporary forms of insomnia arising from sudden emotions, from night watching, after great mental strain, and during the convalescence from fever, it will allay the nervous excitement upon which the abnormal wakefulness depends. In like manner aconite is often useful after fright; cinchona after haemorrhages or other fluxes; ignatia after disappointments or grief; capsicum from homesickness; sticla pulmonalis after surgical operations; natrum muriaticum after adversities; lycopodium from indigestion; cistus canadensis from flatulence; digitalis from constant desire to urinate; tabacum from dilated heart; ferrum from ascarides, and moschus after hysterical excitement.
Cimicifuga is of much value in the sleeplessness of students. I mean, of course, where the lack of sleep is occasioned by over-studiousness. There are some students to whom nux is a better remedy. The cimicifuga patient is oppressed with a peculiar sense of loneliness and apprehensiveness, which he cannot shake off, but which despite his efforts, hangs about him like a funeral pall.
Lupulinum I have used with good effect (third decimal trituration) in several cases of chronic non-febrile disease, where sleeplessness was a wearying concomitant; but it is probably, like coffea, a palliative rather than a remedial agent, and soon wears its influence out. It has a therapeutic relation to opium, and, when more thoroughly proved, we may be able to give it a definite place in the therapy of insomnia.
Scutellaria is another of our indigenous remedies that deserve remembrance. It belongs to the same class as tea, coffee and coca, and it certainly will replace in the nervous disorders of children such drugs as chamomilla, ignatia and belladonna.
Cypripedium is a very close analogue to scutellaria, and it is probable that they both contain the same nervine property. Hale says: "Sleeplessness when depending on functional disorders of the brain and nervous system, or mental excitement, is often promptly removed by doses of the 1 x. This sleeplessness of cypripedium is not an unpleasant condition; there is a desire to talk, a crowding of pleasant ideas, with a restlessness of body, a twitching of the limbs, etc."
The thirty-five remedies which have been mentioned by no means exhaust the materia medica for sleeplessness. Lilienthal gives indications for fifty-two remedies, in his "Therapeutics," and it would be easy to greatly extend that number. But cui bono. Those who believe in homoeopathy as a living and inspiring guide in therapeutics know the sources of their knowledge, while those who prefer the enticing preparations of our manufacturing pharmacists will go on in that broad road that leads but to the grave.
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