sleep then and now - 1805-2005

This web site supplements, augments and documents material presented at the RSM on 22 April 2005 on the history of sleep particularly in relation to the Royal Society of Medicine.

Summary and take home points (site, talk, etc)# The Royal Society of Medicine and Sleep (1805-2005)

  • Major social changes throughout the period make 'then and now' comparisons difficult. Sleep before the industrial revolution may, in many cultures, have consisted of two parts during the night with a substantial period of wakefulness in between. (Ekirch, 2005). The combination of Saints days, and lack of rotas, shift-work, street lighting, and many other factors lead to various sleep patterns. For example, Birmingham artisans would work several days, then rest and play for several days (depending on their workload and Saint Days) - a siesta pattern was also adopted. Lice, bedbugs and fleas *(in the bed), climate change, fire and heating, epidemics, average age of death, medications, diet, etc, etc all had an impact on the general characteristics of sleep which makes population and historical comparisons near impossible.
  • Sleep was thought to compose of at least three types: light, deep and dreaming, and their explanation depended on current medical, philosophical or spiritual models.
  • Treatment of poor sleep varied but depended on existing medical and health models.
  • Over the period 1805-2005, the last fifty years shows a huge surge in interest in sleep, both in terms of basic mechanisms and treatment. The discovery by Aserinsky and Kleitman that rapid eye movements were associated with dreaming probably provided the catalyst.
  • The Royal Society of Medicine showed its interest in the area by agreeing to set up the Sleep and its disorders forum, which is now the Sleep Medicine Section. The forum and section have been holding 2-4 meetings a year since 1999. Other sections that have been involved with 'sleep' are psychiatry and neurology (More information on the RSM, Sleep and its disorders forum ) and the section.


As part of the bicentenary celebrations of the Royal Society of Medicine the Sleep Medicine Section designated its Sleep and Genetics meeting (22 April 2005) as commemorating the event. At this meeting one presentation examined sleep over the period of the RSM's existence 1805-2005. This website provides supplementary material supporting the presentation as well as slightly more interactive elements such as as wiki.


The areas investigated have been:

  • Entries from journals, time-sheets, evidence of working, prayer, social hours, etc. Sailor's watches; Army's watches. How had these evolved.
  • Holidays; evidence of siestas (Birmingham).;
  • Nighttime activities; evidence of early night and late night sleeps.
  • How people slept? Class differences.
  • Scientific and other artefacts - EEG machines, watches, alarm clocks?
  • Clinical artefacts - anti-snoring devices; pharmaceuticals
  • Etc, etc

The WebSite

  • Historical Context
  • Brief history of the RSM
  • Society, science and sleep
  • RSM - the first sleep society?
  • Sleep wiki

A Wiki is a web site that can be edited directly by anyone browsing it. That way new content can be added, errors or inaccuracies corrected, and their own comments added. "http://www.onlamp.com/pub/a/onlamp/2004/11/04/which_wiki.html" review

Brief RSM History

The Royal Society of Medicine (RSM) evolved from numerous London-based medical societies. It's founding arose when many members of the Medical Society of London abandoned this organisation to form the Medical and Chirurgical Society in 1805. The Medical Society of London had originally formed in 1773 to share experiences and promote the then three primary divisions of medicine: physicians, surgeons and apothecaries.

Founding groups (1907)

From 1805 many other medical societies formed as well as the Medical and Chirurgical Society and these were amalgamated in 1907 to form the Royal Society of Medicine.

  • Society of Anaesthetists, 1893-1908
  • British Balneological and Climatology Society, 1895-1909
  • Clinical Society of London, 1868-1907
  • Dermatological Society of London, 1882-1907
  • Dermatological Society of Great Britain and Ireland, 1894-1907
  • Society for the Study of Diseases in Children, 1900-1908
  • British Electrotherapeutic Society, 1901-1907
  • Epidemiological Society of London, 1850-1907
  • British Gynaecological Society, 1884-1907
  • British Laryngological, Rhinological and Otological Association, 1888-1907
  • Laryngological Society of London, 1893-1907
  • Neurological Society, 1886-1907
  • Obstetrical Society of London, 1858-1907
  • Odontological Society of Great Britain, 1856-1907
  • Pathological Society of London, 1846-1907
  • Therapeutical Society, 1902-1907


  • Accident and Emergency Medicine 1987
  • Anaesthesia 1908
  • Balneological and Climatological 1909-1931
  • Cardiothoracic 1991
  • Clinicalb1907
  • Clinical Forensic & Legal Medicine 1988
  • Clinical Immunology and Allergy 1965
  • Clinical Neurosciences (formerly Neurology) 1997
  • Coloproctology (formerly Proctology 1913-1983) 1913
  • Comparative Medicine 1923
  • Dermatology 1907
  • Electro-Therapeutics (see also Radiology & Physical Medicine) 1907-1931
  • Endocrinology 1946
  • Epidemiology & Public Health
  • (Epidemiology 1907-1913; Epidemiology & State Medicine 1913 - 1952; Epidemiology & Preventative Medicine 1952-1974; Epidemiology & Community Medicine 1974-1990) 1907
  • Experimental Medicine & Therapeutics (see Therapeutics & Pharmacology 1907-1943 - joined Medicine to form Medicine, Experimental Medicine & Therapeutics 1973-1987) 1943-1973
  • General Practice with Primary Health Care (formerly known as General Practice 1950-2003) 1950
  • Geriatrics & Gerontology 1991
  • History of Medicine 1912
  • Hypnosis & Psychosomatic Medicine (preciously Mental & Dental Hypnosis 1978-1987) 1988
  • Larynology & Rhinology (formerly section of Larynology 1907-1993) 1907
  • Library (Scientific Research) (became Pharmaceutical Medicine & Research) 1956-1994
  • Measurement in Medicine 1963-2000
  • Medicine (became Medicine, Experimental Medicine & Therapeutics until abolished in 1987) 1907-1973
  • Medical Education 1966-1982
  • Medicine, Experimental Medicine & Therapeutics (see also Medicine Section & Therapeutics and Pharmacological section) 1973-1987
  • Nephrology 1994
  • Neurology (became Clinical Neurosciences 1977) 1907-1997
  • Obstetrics and Gynaecology 1907
  • Occupational Medicine 1964
  • Odontology 1907
  • Oncology 1970
  • Open 1974
  • Ophthalmology 1912
  • Orthopaedics 1913
  • Otology-incl. Otosclerosis Committee 1907
  • Paediatrics and Child Health (previously known as Study of Disease 1908-1946; Paediatrics 1946-1999) 1908
  • Pathology 1907
  • Pharmaceutical Medicine & Research (previously Library - Scientific Research) 1994
  • Plastic Surgery 1967
  • Proctology (see Coloproctology) 1913-1983
  • Psychiatry 1912
  • Radiology 1931
  • Respiratory Medicine 1991
  • Rheumatology & Rehabilitation 1931
  • Sports Medicine 1994
  • Surgery 1907
  • Therapeutics & Pharmacology (Experimental Medicine & Therapeutics) 1907-1943
  • Transplantation 1994
  • Tropical Medicine Section 1912-1936
  • United Services (Previously known as War Section 1919-1929) 1929
  • Urology Section 1920
  • War Section (then United Services) 1919-1929


  • Angiology (Became Vascular Medicine Section) 1986-2002
  • Black & Ethnic Minority Health 2000
  • Catastrophes & Conflict 1999
  • Clinical Haemorheology (amalgamated with Angiology 1997) 1982-1997
  • Clinical Pharmacology & Therapeutics (amalgamated with Section of Pharmaceutical Medicine & Research) 1987-1997
  • Communication in Health Care (formerly Medical Communications) 1986
  • Computers in Medicine 1990-1996
  • Food & Health 1984
  • Learning Disability (formerly Mental Retardation 1983-1993) 1993
  • Lipids in Clinical Medicine 1983
  • Maternity & the Newborn 1982
  • Medical Care of Catastrophes (became Catastrophes & Conflict 1999) 1998-1999
  • Medical Communication (became Communication in Healthcare 2000) 1983-2000
  • Mental Retardation (became Learning Disability 1993) 1983-1993
  • Palliative Care 1996
  • Quality in Healthcare 1991
  • Sexual Health & Reproductive Medicine (formerly Sexual Medicine & Family Planning) 2000
  • Sexual Medicine & Family Planning (became Sexual Health & Reproductive Medicine 2000) 1986-2000
  • Sleep & Its Disorders (became Sleep Medicine 2002) 1999-2002
  • Telemedicine (became Telemedicine & eHealth 2001) 1997-2001
  • Vascular Medicine (formerly Angiology) 2002
  • Venous 1983

Sleep, medicine and the Royal Society of Medicine

The history of the society reflects the changing educational and professional demands of medicine, so it may not be too surprising to find the Society's relationship the same as that with medicine. Sleep may be a state that engulfs most people roughly 25-30% of their daily time and has a major effect both on the physiology and psychology of a person but it debatable whether a speciality is required to manage its disorders? The primary catalyst to have accelerated interest in sleep was the discovery that rapid eye movement sleep as defined using an electrophysiological measure corrleated with dreaming - apparently an objective measure of a subjective state. However, right from this beginning the question has always been should sleep research serve all the medical specialities or should sleep medicine be a speciality in its own right? Should sleep apnoea be treated by a sleep specialists or a respiratory physician? Similarly, should fatal familial insomnia be dealt with by a sleep specialist or a neurologist, ... MORE

The 'Lancet' 'guide' to RSM sleep

Number of references to sleep keywords and the RSM in the Lancet
Sleep Sleeplessness or insomnia Sleepiness Snoring or sleep apnoea
1805- 6 0 0 0
1855 24 17 0 1
1905- 65 17 1 1
1955- 201 23 2 87
The Lancet and the RSM did not get on over their first thirty to forty years. There were arguments over the publication and distribution of the proceedings of the meetings.

Notable' Presidents and fellows

The Society has always had innovators amongst its midst who considered sleep as important scientific and medical problem. For example in the 's was Adrian (xref), Oswald in the 's - and now many more exist within the section and the steering committee ..

'Notable' Presidents and fellows
George Birkbeck1825-1827Birkbeck College
Peter Roget182-1831Thesaurus
Sir Henry Dale1948-1950
Lord Adrian of Cambridge1960-1962
Hughlings Jackson
Prof Ian Oswald
Prof Tony Crisp
Prof Tony Nicholson

Interested sections

  • Experimental Medicine and Therapeutics (formally Therapeutics and Pharmacology) - "The Battle of the Barbiturates"
  • Neurology
  • Psychiatry "Brainwaves and criminality." Freud and Jung
  • History of Medicine
  • Hypnosis
  • etc ...

Sleep and its disorders forum, Sleep Medicine Section

Sleep was not recognised as a subject or a speciality by the Royal Society of Medicine until the setting up of the Sleep and its disorders forum (proposed 1997, approved 1998, first meeting 1999 archives). It became the Sleep Medicine Section, in 2001. Both forum and section are cross-speciality and multi-disciplinary acting as focus for up to date, high quality information on sleep and its disorders. Consequently the membership is diverse, whilst the guiding steering committee consists of specialists with a particular interest in sleep.

Average age of death 1842.

Age of death - 1842 (E.P. Thompson 1963)
  Gentry Tradesmen Labourers
Rutlandshire 52 41 38
Truro 40 33 28
Derby 49 38 21
Manchester 38 20 17
Bethanl Green 45 26 16
Liverpool 35 22 15

Brief History of Sleep

Kleitman (1939 and 1963) reviews theories of sleep by first considering Piéron's 1913 review. Piéron classified theories into 'complete' which account for the sleep-wakefulness cycle, and 'partial' which account for some aspect of the cycle such as falling asleep (but not necessarily what causes awakening).

  • Alcmeon, contemporary of Pythagoras 6thC BC thought sleep was caused by the retreat of blood into the veins.
  • Aristotle thought of sleep as a by product of nutrition.
  • Circulatory
  • Neural inhibition
Year Health, Science & Medicine Social context Sleep Ref
Pre 1800


An endogenous rhythm generator in plants is discovered

by de Mairan (1729)

1800- Winterbottom - Sleeping Sickness
Morphine isolated
Function of spinal nerves noted
Reflecting microscope invented
Anatomy Act passed
Chloroform introduced
Medical statistics introduced
Chadwick reported average life expectancy 45 years (1837)
Electric lighting work
Battle of Trafalgar
Corn Laws repealed
Formation of trade unions
Polidori's thesis on 'sleepwalking'


Purkinje suggested that hyperaemia of the basal nuclei caused compression of the corona radiata thus compressing the thalamocortical tracts causing a disconnecton of the cortex from the sensory pathways.

Osborne thought the choroid plexus swells up and seperates the ventricles that blocking corticopetal impulses.
1850- Darwin On the Origin of Species (1859)
Spirometry invented
X-rays discovered
Various bacilli discovered
Central heating introduced


Duval: Dendrites retract by amoeboid-like movement C.R. Soc Biol. 47, 74-
Social context Hill & Howell: Sleep caused by splanchnic and cutaneous vasodilation. J Exp Med 2, 313-345
1900- Aspirin introduced
ECG work recognised
EEG established
Penicillin first used
DNA basis of genes
Flu pandemic
Encephalitis Lethargica
Golgi Nobel Prize (1906)
1st World War
2nd World War
General strike
NHS introduced

Claparede: Sleep an instinct.

Simpson and Galbraith report the existence of an endogenous rhythm in body temperature in monkeys (1906)


Duval: Dendrites retract by amoeboid-like movement. Cajal suggested that neuroglia might have amoeboid activity and might seperate dendrites. C.R. Soc Biol. 62, 257-

  • Shepard: Sleep not circulatory, but inhibitory
  • The endogenous nature of circadian locomotor activity rhythms in rats is shown by Richter (1922).
Circulation and sleep, McMillan

Pavlov:Generalised inhibition. No sleep centres. Sci Monthly, 17, 603-
1916 Cajal (1932)

  • Dana, Lignac, Pick: all thought on the basis of thalamic tumours that sensory de-afferentiation caused sleep.
  • Beling and von Frisch provide evidence for an endogenous circadian time keepingsystem in bees. (1929)

1935-1937 Sherrington and Adrian (1936)

Bremer: Sleep caused by cortical de-afferentiation

Adrian J Physiol 87:83-84
1942-1950 Fleming Noble Prize (1945)
Dale and Loewi (1949) -HESS?

  • Chaucard observed that neurone impulse transmission times change as sleep begins thus disconnecting most of the cortex from the senses.
  • The first indication of circadian rhythmicity in adrenal function is shown by Pincus (1943).

1950- Crick, Watson & Wilkins (1962)
Eccles, Hodgkin & Huxley (1963)
CT, MRI, etc
Korean War
Vietnam War
Suez crisis
Aden Crisis
NI conflict
Falklands War
Gulf War
Bosnian War
Rwandan genocide
Bünning detects circadian rhythms in isolated sections of intestine maintained in vitro (1958).

The endogenous nature of the human circadian system is reported by Aschoff and Wever (1962).Andrews and Folk record circadian rhythms in adrenal glands maintained in vitro (1964).


  • Oswald: Restorative hypothesis of sleep: Slow wave sleep important for body restoration, REM sleep for brain restoration.
  • Richter provides evidence pointing to the anterior hypothalamus as the location of thebiological clock (1967).
  • The first circadian clock mutants in Drosophila melanogaster are reported by Konopkaand Benzer (1971)
  • Langner and Rensing find circadian rhythms in liver cells maintained in vitro (1972).
  • The localization of the mammalian endogenous circadian clock, the suprachiasmatic nucleus (SCN), is reported by Moore and Eichler, and by Stephan and Zucker (1972).
  • Krieger et al. report the maintenance of food anticipatory rhythms in SCN lesioned animals (1977)..
  • Inouye and Kawamura show that circadian rhythms can be maintained in a hypothalamic island (1979)
  • Groos and Hendriks, Shibata et al. and Green and Gillette show that circadian rhythms of neuronal activity in the SCN can be maintained in vitro. (1982).
  • Bargiello et al. and Reddy et al. localize the period (per) gene in Drosophila (1984)..
Sleep, Penguin

  • Horne: Sleep not generally restorative nor is all needed, but deep sleep might be important for brain restoration.
  • A circadian mutation in the Syrian hamster is discovered by Ralph and Menaker (1988).

Good reading - Sleep and Wakefulness, Nathaniel Kleitman, 1939, 1963

Brief history of biological clock

  • Ralph et al. show that the transplanted SCN determines circadian period (1990)
  • Vitaterna et al. identify the first circadian mutation, Clock, in the mouse (1994).
  • Autonomous single-cell circadian oscillators are reported by Welsh et al.(1995)
  • An independent circadian clock is found in the mammalian retina by Tosini and Menaker (1996)
  • Sun et al. and Tei et al. identify the mammalian orthologue of the period gene of Drosophila (1997)
  • Giebultowicz and Hege describe an independent circadian clock in the peripheral tissues of Drosophila (1997).
  • The expression of clock genes in mammalian peripheral tissues is shown by Zylka et al.13 and Balsalobre et al. (1998)
  • Van der Horst et al. show that the lightcapturing proteins of plants have an essential role in the mammalian clock (1999).
  • Lowrey et al. localize the tau gene (2000).

Sleep disorder treatments?

BMJ, 1885, p874COLD BANDAGING OF THE LEG IN INSOMNIA -Dr von Gellhorn has found the following plan very useful in inducing sleep in persons who suffer from insomnia. A piece of calico, about eighteen inches wide and two and three quarter yards long, is rolled up like a bandate and a third of it wrung out of cold water. The leg is then bandaged with this , the wet portions being carefully covered by several layers of the dry part, as well as by a layer of gutta-percha tissue, and a stocking drawn on over the whole. This causes dilatation of the vessels of the leg, thus diminishing the blood in the head and producing sleep. It has been found by Winternitz that the temperature in the external auditory meatus begins to fall a quarter of an hour after the application of the bandage; the decrease amounting to 0.4C, and the normal not being again reached fro from one and a half to two hours afterwards. The author has employed this means of procuring sleep for a couple of years and finds it especially useful in cases where there is congestion of the cerebral blood vessels. Sometime he has found it is necessary to reapply the bandage every three or four hours, as it dried.
The Lancet, 1919SLEEPING CAP - (Allen & Hanbury's - occludes eyes and ears)
BMJ, 1911A NEW NIGHT TERROR - the motor car
BMJ 1930Letters, notes and answers:- BROKEN SLEEP - Dr. S "asks for suggestions for the treatment of sleeeplessness in the early morning. He writes: I can sleep till about 3 or 4 o'clock in the morning but not after that. I have turned 70, and have carried on a fairly large practice for over twenty years in an industrial town, without the aid of car or cycle. Apart from the insomnia, I am quite healthy. I usually go to bed at 10.30pm. I have tried bromides and aspirin, without any benefit.
BMJ 1930Letters, notes and answers:- M.W. (London), replying to the question of "Broken Sleep" I suggest Dr. S shuld try dial 1 1/2 grains at bedtime if the insomnia is not associated with pain. [(diallybarbituric acid)]
BMJ 1930Letters, notes and answers:- B.H. writes: DS's troubles may be in part due to chilliness at 3 or 4am., or possibly to early morning noises, after which he awakens. Some form of head covering and a screen round the head of the bed might be useful and medinal 7 1/2 grains at bedtime occasionally is very effective. ([barbitone])
BMJ 1930Letters, notes and answers:- "E" writes in reply - For wakefulness in the early hours of the morning I suggest a cup of hot tea with an unsweetened biscuit. I find this very useful.

Dr Hughlings Jackson, Profs Adrian, Bradley and Bradbury's views on sleep
Lecture presented to the Neurological Society (one of the founding RSM societies). Considered that movement did not occur in dreams because few nerve cells represented large muscle movements at the higher levels of the nervous system, they cannot overcome the 'resistance' of motor nerve cells in the 'middle' region. Regarded dreams as normal nervous system shutdown. Considered somnambulism as sleep with elaborate actions. "The rule is, nothing is remembered on full awakening ... To say that there is no dream in simnambulisem is hoever to say more than one can know; it is better to say that nothing is remembered from the state of somnambulism on awakening. Here is an old question, s even deepest sleep ever dreamless? (Leibnitz, Kant, Jouffroy and Sir W. Hamilton thought sleep was never dreamless.) I feel sure that in somnambulism there are some nervous activities of lower layers of the highest level, determining, by sub-agency of motor centres of lower levels, the elaborate actions of the somnambulist; there may or may not be mentation (a dream unremembered on recovery) attending those activities." Relations of different divisions of the central nervous system to one another and to parts of the body, Lancet, 79-87, 1898
Prof ED Adrian, The Physiology of Sleep. (John Mallet Purser Lecture at Trinity College, Dublin.) Considered how the nervous system might fall asleep, and more remarkably how it wakes up. Notes different behavioural patterns in animals (monophasic versue polyphasic patterns), e.g. monphasic ringed snake rises at noon and goes to bed at 1.30pm; polyphasic rabbit with 16-20 regularly spaced rest periods throughout the 24 hours. Babies polyphasic, adults monophasic. Compares normal sleep with sleep-induced by narcotics. Considers automatic and semi-automatic processing of stimuli. Sleep and awareness. Focusses on the importance of the diencephalon and the work of surgeon Penfold.Lancet, 1296. 1937.
Bradley: "Why when we strive to move in dreams do we not always move?"FH Bradley, On the failure of movement in dreams, Mind, 373, 1894.
Considered morphine and its derivatives, cannabis, hyoscine (and Jamaican dog-wood, some species of lettuce). Treatment of insomnia - "... the first great principle of therapeutics -the removal of the cause- should bever be kept in mind, the relief of the symptom being regarded as secondary to this." JB Bradbury, Some points connected with sleep, sleeplessness and hypnotics. Lancet, 1899.
Hughlings Jackson suggesed that during sleep the brain carries out some active processes that contribute to waking function and "find out about dreams and you will find out about insanity." He noted the changes in respiration and retinal blood-flow during sleep (but then he seems to have observed and thought about everything.

EF Buzzard - Presidential address to Psychiatry Section (from Lancet, 1920. Some Aspect of Mental Hygiene.

"There is no doubt in my mind that the invatders of our borderland have unduly minimised the importance of rest as a physiological essential in the prevention and cure of psychoneuroses. Rest and sleep, must to the end of the chapter, be necessary in treating a condition of exhaustion, however the latter is produced. It is contended that with simple fatigue, uncomplicated by an anxiety state, sleep is undisturbed and refreshing. But it must be remembered that fatigue of itself may convert potential anxieties into active anxieties by reason of that loss of sense of perspective and of proportion by which it is almost invariably accompanied. In this way insomnia and disturbed sleep are brought about and a vicious circle established. This is a matter of everyday experience, and one which must not be lost sight of in any system of mental hygiene."

INCIDENTAL NOTE - The Aftermath of Eye-Strain, S Stephenson - Lancet, 1910: "The late Mr Simposon Snell spoke of insomnia as a frequent manifestation of eye-strain and commented upon the fact that natural sleep speedily returned when relief had been afforded over-taxed eyes by correcting glasses.


Characteristics and REM Theories Characteristic Theoretical Function
Emotional contents of dreamsEmotional adaptation
Follows NREM sleepCompensates for NREM restorative process
Cerebral arousalCompensates for NREM quiescence
Provides periodic endogenous stimulation
Prepares for awakening (sentinal function)
Promotes cerebral maturation
Motor inhibitionProtects infants when brain activity is high
Increased brain temperatureWarms brain after NREM cooling
Eye movementsExercises binocular coordination
Locus coeruleus quiescenceUpregulates catecholamine receptors
Behaviors of cats without REMRehearses genetically sleep motor inhibition programmed behaviors
Hypersynchronous theta EEG in hippocampusFacilitates memory consolidation
Increased brain protein synthesisProtects neural circuitry subserving memory
Bizarre dreams that are mostly forgottenWeakens useless memory traces


Good reading - Sleep and Wakefulness, Nathaniel Kleitman, 1939, 1963