Opium, alcohol, and liquid food, are the best hypnotics in such cases. The acetum opii and the deodorized tincture of opium are among the best preparations of the drug, by reason of their stimulant effect. The equivalent of two grains of opium with a full glass of eggnogg, will often procure sleep for such a patient. If there be evidence of blood stasis, with blueness of the nails, hypostatic pneumonia, etc., musk and strychnia should be given in place of opium, and the circulation should be assisted with carbonate of ammonia, as follows: ℞ Ammon. carb., gr. v. Spt. chloroform, gtt. xx. Aq. camphor, ℥ ss. To be given in a little milk, as required. Chloral and the bromides are of comparatively little value in all cases where there is considerable depression of the vital forces. _Insomnia in rheumatism and gout._--Opium in a diaphoretic preparation, and associated with alkalies or with colchicum, has always been the most approved remedy for sleeplessness in the acute forms of these painful diseases. Salicylic acid and the salicylates have in great measure superseded the use of opiates for the relief of pain and wakefulness in rheumatism, but they are not always efficient. Opiates, with or without chloral, must then be used. Sometimes a painful case that has resisted all other remedial agents yields promptly to the action of a series of blisters. The chronic forms of rheumatism require the use of stimulant diaphoretics, anodyne liniments containing chloroform and belladonna, and chloral hydrate, or even a Dover’s powder, at night. Acute gout is rarely seen in this country, but its rudimentary forms, described by Da Costa as _lithæmia_,[54] are not uncommon. They are associated with wakefulness of a very troublesome character, which only yields to a persistent and long continued course of treatment directed against the diathesis. Careful regulation of the diet, change of air, and anti-arthritic remedies, are of infinitely greater service than any particular hypnotic drug.