If, however, the disease should resist all these anti-spasmodics and soporifics, besides the remedies addressed to the predisposing causes of the malady, the only thing that remains is a change of locality. Many very desperate cases have thus been restored to health and comfort. _Insomnia in renal disease._--In the acute forms of renal disorder this is usually caused by pain and fever. It is, therefore, to be relieved with opiates given in connection with such arterial sedatives and diaphoretics as each individual case may require. But the tendency of inflammatory diseases of the kidney to merge in uræmia must not be forgotten, and the soporific must be used in such cases with great caution. For this reason hyoscyamus is often preferable to an opiate. In extreme dropsical conditions the measures that are useful for the reduction of anasarca constitute the most efficient means for the induction of sleep. In nephritic colic pain is too severe to admit of any rest while it lasts. The general treatment of colic is all that can occupy the attention until relief is secured. The dyspnœa and wakefulness sometimes experienced in advanced cases of Bright’s disease may be greatly relieved by the judicious use of morphia, very much as in the similar disorder occasioned by chronic diseases of the heart. _Insomnia in diseases of the liver._--Inasmuch as the majority of these diseases interfere with the formation and proper discharge of bile it is desirable to avoid, as far as possible, the use of opiates in the disturbances of sleep that are so commonly consequent upon disorder of the liver. Simple restlessness at night can usually be obviated by the ordinary treatment that is remedial of the disease by which it is caused. But it often happens that hypnotic remedies must also be employed. Hyoscyamus, belladonna, chloral hydrate, and compound spirit of ether, are frequently useful. Sometimes when the evacuations exhibit a deficiency of biliary coloring matter, a grain of opium, with a few grains of calomel, forms a very efficient hypnotic. Alcoholic soporifics are not well tolerated when the gastro-intestinal mucous membrane is diseased. Biliary colic demands treatment similar to that that is required in nephritic attacks. Warm baths, fomentations, and a broad belt of oiled silk around the body, are very grateful, and are favorable to the induction of sleep. A course of nitro-muriatic acid, internally and externally, is often useful when wakefulness is associated with torpidity of the liver.[53] _Insomnia in gastro-intestinal diseases._--In acute inflammatory conditions of the stomach and bowels, sleep must be invited by the use of opiates. Bismuth and morphia, with hydrocyanic acid, are the favorite means of obtaining relief. Opium in solid form is sometimes preferable when a slowly developed and long continued impression is desired. Warm baths and hot poultices also give great relief.