_Lactucarium_ may be classed with the weaker opiates. It possesses very little value. Its fluid extract is sometimes prescribed at night to allay the cough of pulmonary consumption, so as to favor sleep. _Bromides._--According to Mitchell, Echeverria, and Bartholow, the soporific energy of the bromides may be ranked as follows: Lithium bromide first, sodium bromide second, potassium bromide third. Hammond praises calcium bromide. Hydrobromic acid is also employed as an hypnotic in certain cases. As a clinical fact the bromides of sodium and potassium are most frequently employed for the relief of insomnia. Of these the second is most useful when sleeplessness is associated with the phenomena of irritability; the first is less energetic in its effects upon the motor structures of the body. The bromides act upon the protoplasmic constituents of the body, directly inhibiting their functional energy. Upon the spinal cord they act to diminish reflex excitability. Under their influence the receptivity and functional capacity of the brain is reduced. The minute blood vessels contract in consequence of the inactivity of the tissues which they supply. A lethargic sleep is thus induced. For the reasons above stated the bromides find their greatest opportunity for usefulness in cases of over-excitement and exhaustion of the brain. When the cortical cells have degenerated into a condition of irritable weakness, characterized by inordinate instability of substance, the bromides serve to steady the fabric by retarding those movements of disintegration which produce morbid wakefulness. Almost useless in cases marked by active congestion of the brain, they are invaluable in the insomnia produced by excessive mental exertion, care, emotion, worry and fatigue. The wakefulness of hysteria, of asthenic mania, and of sexual excitement, is often greatly relieved by the administration of the bromides. The prodromic stage of delirium tremens, before any violent outbreak, and the wakefulness of convalescence from acute diseases are often cured by their use. Mental disturbances and morbid impulses associated with pregnancy or the puerperal state may be dispelled in the same way. The screaming fits of night terrors in children are benefitted by these medicines. They seem to increase the efficacy of chloral, chloroform, ether, cannabis indica, hyoscyamus, belladonna, and the opiates. The hypnotic dose of hydrobromic acid is twenty-five grains, largely diluted with sweetened water. For this reason, and for its disagreeable taste, it is not an eligible preparation. Lithium and calcium bromides may be given in scruple doses every hour or two till sleep is produced. Sodium and potassium bromides should be given in doses of thirty or forty grains every two hours. It is sometimes remarked that instead of favoring sleep the bromides only increase wakefulness. In such cases opiates and alcoholic stimulants are usually indicated.