Insomnia is often not only a troublesome factor, but one which seriously complicates other conditions, especially those of an acute and asthenic character. During the progress of chronic disease, or as a precursor of nervous prostration, insomnia should have the very first consideration. "In those who perform mental work persistently, which requires that an increased amount of blood shall flow to the brain, inducing a condition of distention of the cerebral vessels, the vessels temporarily lose their contractility from the prolonged distension. This is especially true if the mental effort is intense, or if it be persevered in, without periods of alternation or rest.

It is but natural, then, that the vessels remain engorged, and thus preclude the possibility of sleep from the state of cerebral congestion.

"These individuals feel very tired when they go to bed, and believe that they can go to sleep at once, but immediately they find that their minds become inordinately active, and hour after hour the thoughts go surging through the brain as they recall the events of the day, or as the mind indulges in extravagant imaginations. Unpleasant things become greatly magnified, and things which would otherwise bring pleasure are either excluded or are perverted into that which is unpleasant. The blood vessels fail to empty themselves because they have lost their power to do so. They are like rubber bands that have remained for a long time around packages, or like a rubber tube that has been a long time distended. The elasticity which they once possessed has gone."

I have somewhere read the above statement, and for treatment, rest, a general definite restoration of tone, is more to be desired than desultory medical treatment for the symptoms. An improvement of the circulatory organs including the bloodvessels and a complete restoration of the nervous system must be accomplished. It is not difficult to see with the above pathology how strong anodynes and sedatives increase the actual condition.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.