Chloralum hydratum crystallisatum, Hydrate of Chloral.

Formula

, C2 HCl3 O+H2

O

Preparations , Triturations.

Authorities.

1 , Dr. W. Eggert, proving with 72 grains on a lady, Hahn. Month., 6, 22; 2 , ibid., proving with 30 and 55 grains; 3 , Dr. S. Swan, proving with repeated doses of the 200th dil., Med. Invest., 9, 547; 4 , Dr. D. A. Babcock's provings, Inaug. Thesis, N. Y. Hom. Med. Coll., 1874, 6th dec. trit., frequently repeated doses; 5 , ibid., proving with 15 grains crude drug; 6 , ibid., proving with 1/10th, repeated doses; 7 , ibid., proving with 2 grains crude; 8 , ibid., proving on G. A. T.; 9 , ibid., proving on P. H. M.; 10 , ibid., proving on Mr. B.; 11 , ibid., proving on Mr. B. with 6th dil.; 12 , ibid., proving on Miss R. with 15th trit.; 13 , J. B. Andrews, experiments, Am. J. of Insanity, July, 1871; 14 , F. E. Anstie, cases of poisoning, Practitioner, 12, 104; 15 , Crichton Browne, effects on patients, Practitioner, June, 1873; 16 , Dyce Brown, action on skin of 5 grains, thrice daily, in hooping-cough, Month. Hom. Rev., 15, 347; 17 , ibid., effects of 10 grains, thrice daily, in a young lady; 18 , E. T. Blake, effects of ordinary doses, B. J. of Hom., 1871; 19 , Dr. Cairns, proving, 1 drachm (first night), 2 drachms (second night), 3 drachms (third night), Ed. Med. Jour., 1870, p. 375; 20 , Dr. Curshman, effect on larynx in a patient, Practitioner, June, 1873, p. 364; 21 , H. Derby, experience, with doses of 30 to 75 grains, in eye and ear infirmary, Bost. Med. and Surg. J., Dec. 1869; 22 , Geo. Dabbs, effect of 20 grains, taken twice in half an hour, Med. Times and Gaz., 1870, p. 435; 23 , Drasche, effects on a man with fracture of lower leg, Monograph on Chloral, 1869 (A. H. Z., M. B., 21, 15); 24 , ibid., effects of half a drachm; 25 , ibid., effect of 40 grains; 26 , ibid., effect of 45 grains; 27 , effect of 2 scruples in a student, ibid.; 28 , G. S. Elliott, effect of 40-grain doses on self, taken experimentally, Lancet, 1870, p. 786; 29 , G. T. Elliott, chronic effects of at least 200 grains every twenty-four hours for months, Lancet, May, 1873; 30 , A. Fraser, effect on conjunctiva of 30 grains daily, Month. H. Rev., 15, 347; 31 , Husband, effect on skin of 20-grain doses daily for eight days, and then 30-grain doses twice daily for 5 days, Practitioner, June, 1873; 32 , Kirn, effect in patients, Practitioner, June, 1873; 33 , Levinstein, poisoning by 4 drachms (Wien Med. Clin.), N. Y. J. of H., 2, 344; 34 , H. J. Manning, effects on a monomaniac, Lancet, May, 1873; 35 , R. J. McKay, tox. by 5 drachms in four hours, N. Y. Med. Rec., 1870, p. 284; 36 , Wm. K. Murphy, chronic effects on female with affection fo bladder (20 grains at night, and finally 150 grains a day for six months), Lancet, August, 1873; 37 , ibid., effects on sleepless female of 40 grains at bedtime, increasing by 20 grains to 120 grains in twelve hours for four months; 38 , ibid., on sleepless female, 60 to 70 grains a day for two years; 39 , ibid., on sleepless young man, taken from a bottle "by guess" for eighteen months; 40 , Nicol and Mossop, observation with the ophthalmoscope on selves, after 10 grains to a drachm, Br. and F. Med.-Chir. Rev., July, 1872; 41 , J. Fred. Plumley, general effects, Lancet, Feb. 1870; 42 , Thos. S. Ralph, microscopic appearance of blood after small doses, Month. Mic. Journ., 6, 78; 43 , J. V. Laborde, Archiv., Gén. d. Méd., Dec. 1869, effects on healthy men of progressive doses of 1 to 2 grammes daily; 44 , J. Russell Reynolds, tox. from 10 grains, increased to 50 or 60, N. Am. J. of H., N. S., 5, 115; 45 , O. H. Leeds, tox. from doses of 20 grains, Am. J. M. S., Jan. 1872; 46 , N. R. Smith. Bost. M. and S. J., 1871 (affection of skin); 47 , Dr. Snell, tox. from solution of 1 ounce, Phila. Med. Times, 5, 812; 48 , J. H. Sherman, effects of half an ounce, N. E. Med. Gaz., Sept. 1874; 49 , Schule, general statement of effects on patients, Practitioner, June, 1873; 50 , J. K. Warren, fatal poisoning by greater part of one ounce, N. E. Med. Gaz., 6, 120; 51 , effects of 9 grains, N. Y. Med. J., 16, 332; 52 , effects of 7 1/2 grains on a woman, aged 68, suffering from goitre and tumultuous action of heart; 53 , experiment with 2 scruples, A. Hom. Obs., 1870, p. 293; 54 , effect of 7 drachms, Am. H. Obs., 1870, p. 472; 55 , effect of 15 grains, N. Am. J. of Hom., N. S., 5, 115; 56 , J. R. Reading, effects on a healthy man, N. Am. J., N. S., 5, 114; 57 , effects, N. Am. J. Hom., N. S., 5, 114; 58 , Dr. Oehme, effects of 5 grains for toothache, El. Crit. Med., 1874 (Raue, Rec., 1875).

MIND

Emotional.
Feeling as though he had been intoxicated by wine (soon), 27.
Feeling of intoxication when first awaking; this soon passed off, 41.
All the phenomena of delirium tremens, 29.
Pain (from an ulcer in cornea) relieved in half an hour after taking, but the patient became somewhat delirious, and being missed from the ward, was found wandering about alone in the upper stories of the building (60 grains), 21.
Became delirious, and hurled a hot-water bottle at an imaginary figure which stood menacing her at the foot of the bed, 18.
A consciousness of everything going on around him, with an inability to resist giving utterance to what he knew to be profound nonsense (3 drachms after ten minutes), 19.
A pleasant excitation for a quarter of an hour, with pulse 88 (before taking 68), (immediately), 53.
In answer to questions, he said that his condition was of the most agreeable kind (soon), 27.
Lively mood, with loud laughing and witty remarks (very soon), 27. [10.]
A muscular and moral excitability similar to a slight champagne intoxication, whereby the prover felt pleasant, smiled, and danced, 53.
Generally so much reduced was she, alike in morale and in physique , that though once an accomplished horsewoman and habituated to danger and fatigue, she constantly evinced the profoundest terror without any adequate cause, and was unable to walk a hundred yards without sinking from sheer exhaustion, 38.
The temper, never very good, has been much more irritable than usual ever since, 19.
From having been a cheerful, upright, exceptionally intelligent, and strong-willed woman, she had become morose, deceitful, and imbecile alike in intellect, memory and will, 36.
From having been a woman of strong will and excellent mental power, she became listless and peevish, childish, indeed, in many things, begging for chloral, 37.
Intellectual.
Inability to concentrate thought (second day), 10.
Confusion of thought; after an hour mind wandered much, 44.
Great confusion of mind; a feeling as if he were now in one county and now in another, and with an anxious desire to get home (3 drachms after ten minutes), .

HEAD

Vertigo.
Vertigo, 45.
General Head. [30.]
Veins of head and neck filled to bursting (after one hour), 33.
Head bent upon chest (after four hours), 22.
Uncomfortable feeling about head all day, 7.
Two or three of the patients complained, on waking, of headache, lasting from one to three or four hours, 21.
Feeling of fulness and constriction in head, at 8 A.M. (second day), 10.
Dull feeling in head all day; it seemed full (second day), 6.
Dull aching pain in head, on waking in morning, which lasted all day (second day), 10.
Dull aching pain in head, aggravated by sudden motion (second day), 10.
Forehead.
Severe pain in frontal region right over the supraorbital ridge, which nothing relieved, aggravated by movement (soon after), 5.
Headache in forehead, extending to occiput (after two-thirds of an hour), 6. [40.]
Headache over both eyes, running down in the eyes, left side worse, with feeling as if the eyes were constricted; within two hours it gradually passed away (after two hours), 8.
Severe headache, lasting about two hours; a feeling of fulness over the eyes, especially over left eye, accompanied with some nausea and sour eructations of liquid, supposed to be what had been eaten for breakfast (after two hours), 9.
Feeling as if a hot band was drawn across the forehead from temple to temple, directly over the eyes, with sensation of a burning ring around each eye (after a few minutes), 5.
Dull, heavy, pressing headache over the eyes, more particularly the left, while at supper; it lasted about an hour, and then gradually wore away (after one hour), 9.
Occiput.
Dull, heavy headache in occiput, and forehead over the eyes; a feeling of weight and soreness, and seems wholly inside the cranium; aggravated by moving about, and on lying down, but slightly relieved by going into the open air (after one hour and a half), 4.
External Head.

EYE

Redness and watering of the eyes, lasting for two days, 30.
Eyes bloodshot and constantly watering, 36.
Eyes bloodshot, and as if starting out of their sockets (3 drachms after ten minutes), 19.
Eyes suffused and half-covered by the drooping eyelids (1 ounce), 14. [50.]
Eyes became inflamed and weakened, and there was burning lachrymation (3ss. daily for two months), 14.
For three weeks the eyes were much inflamed, and unable to bear the light without pain, 19.
The disk after the dose was seen to have a transparent appearance resembling white wax; the retina was always found paler than before taking; the central artery and vein and their branches were darker in appearance, and seemed to stand out more prominently, 40.
A state of capillary congestion was found in the left disk on two occasions; once it came on very soon after the light was thrown on the retina, on the other occasion it was observed front the first (1 scruple), 40.
A general haziness of the fundus was noticed on one occasion in both eyes, when sleep had been produced (1/2 drachm after one hour), 40.
Stared wildly about (soon after), 51.
Eyes set and glassy (after twelve hours), 50.
Brow.
Great fulness over eyes, with pressing headache (after one hour), 12.
Lids.
Eyelids became red and swollen; conjunctiva injected, 45.
Eyelids closed, and with some little difficulty opened (after four hours), 22. [60.]
Temporary ptosis (in an overworked man), 18.
Lachrymal Apparatus.
Lachrymation (after one hour and a half), 33.
Conjunctiva.
Redness, swelling, and secretion of the conjunctiva, 32.
*Conjunctiva congested (after twelve hours), 50.
The conjunctivæ were more congested after the effects of the drug were fully manifested, 40.

EAR. [80.]

Constant tinnitus aurium (1 ounce), 14.

FACE

Wistful, haggard expression in the face (1 ounce), 14.
Face dusky, 47.
Face quite purple (3 drachms, after ten minutes), 19.
The face, to the roots of the hair and down to the ramus of the lower jaw, was of a dark-scarlet color, which was very persistent under pressure, most intense over cheek-bones, and shading in different directions; the ears partook of the same color, which was scattered in blotches over neck and chest, the lowest spot being at the centre of the sternum; this flushed condition was accompanied by slight contraction of the pupils, injection of the conjunctiva, and an excitement of the circulation; it continued for about an hour, and passed off during a paroxysm of sneezing (after half an hour), 55.
Face, forehead, the whole head to the neck, suffused with a deep redness (after one hour), 33.
Face and eyes very red (after one hour), 24.
Face becomes red and the eyes glittering (soon), 27.
Face flushed (55 grains, after twenty minutes), 2.
Face flushed and anxious, 36. [90.]
Face intensely flushed (after four hours), 22.
The use of any alcoholic stimulant, even claret in very small quantities, would flush his whole face, suffuse his eyes, and bring on almost at once a severe headache, which was almost always at the back of the head, "about the cerebellum" (1/2 ounce daily), 14.
Looked pale and anxious (second day), 51.
Unusual pallor of countenance, although the pulse continued as before taking (observed in several cases), 28.
Deathly paleness of face, with Hippocratic expression, veins sunken in (after one hour and a half), 33.
Rush of blood and sensation of heat in face, which lasted only for a minute or so (after a few minutes), 5.
Jaws.
Teeth firmly closed (after ten minutes), 35.
Teeth "fixed" (soon after), 51.

MOUTH

Gums.
Gums spongy (20 grains thrice daily), 15.
Tongue.
White, thickly-furred tongue, 29.
General Mouth. [100.]
The lips and mucous membrane of the mouth were excoriated; in five days the ulceration of the mouth had extended further; the lips were covered with crusts (20 grains thrice daily), 15.
Saliva.
Frothy mucus flowed from the mouth, and it seemed filled with a membranous substance, not unlike that of membranous croup (after twelve hours), 50.
Speech.
Expressed himself in a peculiar broken speech, as if partially drunk (1 ounce), 14.

THROAT

Came near strangling by spasm of the throat, involving apparently the epiglottis, 57.
Moderate catarrhal sore throat, with pain in the fauces (three cases), 32.
Awoke at 7 A.M. with feeling as of a cold in head; throat and posterior nares seem sensitive, raw, and burning (second day), 6.
Fauces and Œsophagus.
Unless largely diluted, it produces a burning sensation in fauces and stomach, 13.
Partial paralysis of the œsophagus , accompanied by a nervous disinclination to take food or drink, and seriously interfering with nutrition of patient, 38.
Partial paralysis of the œsophagus, not spasmodic stricture; the muscles contracting, indeed, but sluggishly and incompletely, under the stimuli of food and drink; recurred at intervals for many months, even after convalescence was established, 36.
Swallowing.
Deglutition difficult, the act not beginning till he strangled and coughed (after forty minutes), 35.

STOMACH

Appetite. [110.]
Loss of appetite, 29.
Hardly any appetite for dinner, 9.
Thirst.
Great thirst, 29.
Urgent thirst, 44.
On awaking in morning, intense thirst, with dryness of tongue and fauces, headache, vertigo, nausea, and great nervous sensibility, 39.
Eructation.
Acidity of stomach; regurgitation of food tasting very sour (after one hour), 12.
Nausea and Vomiting.
Nausea, 45

(especially on second or third day), 43.

In some instances, it has induced nausea and vomiting, 13.
Sense of nausea and oppression in stomach, without inclination to vomit; an uneasy feeling in stomach; nausea and stomach symptoms seemed to be relieved by eating supper, but came on again later in the evening (after one hour and a quarter), 4.
Retching (after fifty-five minutes), 1. [120.]
Slight retching (55 grains, after one hour and five-sixths), 2.
Slight tendency to vomit, 22.
After the first dose, whether she had the whole or a part, she always was sick, so that a double dose was used every night (noticed in three other cases), 37.
Stomach.
Belching of wind; lasted until after eating (after five minutes), 8.
Sense of emptiness shortly after eating, as if he had not eaten, 3.
Intolerable sense of sinking and oppression at pit of stomach, 44.
Pain in stomach and abdomen, accompanied by slight difficulty of respiration (second day), 10.
Extremely painful sensation at pit of stomach (especially on second or third day), 43.
Sharp pains in epigastric region (after two hours), 11.

ABDOMEN

Severe colic (especially on second or third day), 43.

STOOL

Diarrhœa. [130.]
Was seized with diarrhœa about two months before she died (produced, I fear, by the Chloral); during this diarrhœa she passed a large amount of gelatinous matter in the stools, 37.
Three stools during the day (second day), 7.
Two stools during the day, instead of one, 7.
Two loose stools, in afternoon, 7.
Two soft light-yellowish stools, voided with some sharp pains in the rectum (after seven to nine hours), 9.
Soft, lumpy, strong-smelling stools twice a day, and frequent passage of fetid flatus, 7.
Soft yellow stool, in evening (after nine hours), 7.
Stool, in morning, soft, but voided with great pain in the rectum (third day), 9.
Constipation.
Constipation, 29.

URINARY ORGANS

Frequent and profuse urination of a dark amber color, clear and no odor, 3. [140.]
Urinated copiously in bed without knowing it, 58.*

SEXUAL ORGANS

Copious nocturnal emission, 4.
Seminal emissions at night (it being only a week since the last), and again on the following night), 5.

RESPIRATORY ORGANS

Larynx.
Pronounced redness and swelling of the epiglottis and of the false vocal cords, 20.
Respiration.
Breath fetid (20 grains thrice daily), 15.
Constantly fetid breath, 29.
Odor of Chloral in breath something sickening (after four hours), 22.
Respiration stertorous (after twelve hours), 50.
Stertorous breathing, with loud snoring during sleep in any position; when lying on the back, the inspiration was through the nose, while the expiration was blown through the lips, as in apoplexy, 3.
Gasping breathing, 44. [150.]
Respiration so hurried as to "resemble the panting of a dog" (3 drachms, after ten minutes), 19.
Respiration 48, shallow, and loudly stertorous (after ten minutes), 35.
Respiration slow, labored, and stertorous (after ten minutes), 35.
9 and 10 A.M., respiration 20 (before taking); 16 (after one hour); 18 (after three hours); 18 (after seven hours); 20 (after eleven hours), 23.
The patient was found breathing heavily, at times stertorously, 47.
Very laborious respiration, with occasional deep inspirations, with a sighing expiration, 3.
Respiration quiet, and at times imperceptible, 37.
Respiration intermitting (after one hour), 33.
Sense of suffocation and oppression of chest, in front and at its base, 44.
Great dyspnœa, 44. [160.]
Attacks of extreme dyspnœa, which increased to asphyxia; at the same time the face was swollen, the facial muscles paralyzed, and there were also all the signs of cerebral effusion (45 grains daily), 32.

CHEST

Singular sensation of fulness of chest, not as if it was filled up, as a person experiences after a hearty meal, but rather as if all the tissues were hypertrophied, producing an indescribable sense of tightness and pressure on the lungs, causing very labored breathing and redness of the face, which attracted attention; this condition was so uncomfortable that he discontinued the proving, and it was several days before he could breathe freely, 3.
Used regularly to suffer after meals from a sense of oppression which made going upstairs extremely difficult, and even interfered with speech, although there was no chest disease to account for this; the symptoms persistently recurred in spite of all treatment till the chloral was left off, when the oppression entirely disappeared, 49.
Sense of weight on the chest, in the region of the sternum, at night, causing an expiration to be easier than an inspiration, 3.

HEART AND PULSE

Præcordium.
Sounds of the heart indistinct (after one hour and a half), 33.
Heart's Action.
The primary action is to increase the force of the heart's action and arterial tension, 13.
Action of the heart so violent that its pulsations could be heard at a distance (3 drachms, after ten minutes), 19.
As soon as she took a glass of beer there was strong pulsation of the arteries, and the whole face was swollen and of such an alarmingly deep color that we were obliged to forbid the use of wine and beer (30-45 grains), 32.
The secondary effect is to diminish the force of the heart's action and arterial tension, 13.
Heart acting regularly, but with increased frequency and diminished force, 44. [170.]
Motion of heart quite rapid, but so feeble as to be scarcely felt (after twelve hours), 50.
Pulse.
Slight increase of pulse, 3.
Pulse rapid, weak, and wavy (after forty minutes), 35.
Radial temporal, and tibial pulses frequent, weak, and irregular, in both force and rhythm, and frequently intermittent; after an hour, the superficial pulses almost imperceptible, 44.
Pulse 74 (before taking, 68), 53.
Pulse weak, and about 76, 47.
Pulse 84 (76 is normal), (after half an hour), 6.
Pulse 88 3

(55 grains, after forty minutes), 2.

Pulse ran up from 76 to 88 (30 grains, after fifteen minutes), 2.
Pulse 90; whole body extremely relaxed, except the left leg (after forty-five minutes), 1. [180.]
Pulse 92 (55 grains, after thirty-five minutes), 2.
Radial pulse hard, 92 (after one hour), 33.
9 A.M., pulse 72; 10 A.M., pulse 80 (before taking); pulse 84 (after one hour and a quarter); pulse 92 (after three hours); pulse 90 (after seven hours); pulse 80 (after eleven hours), 23.
Pulse risen from 80 to 100 (55 grains, after six minutes), 2.
Pulse 100; sleeps; face commenced to flush up bright-red (after fifteen minutes), 1.
Pulse 108 (after twenty-five minutes; after one hour), 1.
Pulse 120 (20 grains thrice daily), 15.
Pulse 120; sleeps with snoring; face flushed of darker hue (after twenty minutes), 1.
Pulse slow, feeble, and intermittent, 36.
Pulse fell from 125 to 100 in half an hour (75 grains), 21. [190.]
Pulse quick and bounding; its frequency about 120, but gradually decreasing till (after seven hours and a half) it was only 96, 22.
Pulse fell from 120 to 90 in about half an hour, with increasing drowsiness (60 grains), 21.
Pulse fell from 96 to 84 in half an hour (45 grains), 21.
Pulse sunk from 88 to 80 (after five minutes), 1.
Pulse fell from 80 to 70 in half an hour (45 grains), 21.
After the dose, her pulse, generally small and 80 per minute, would fall from 10 to 12 beats; it would, after the lapse of half an hour or so, rise to 90, and even 100, and then, after some time, fall to its normal state; it was hard, but regular, 37.
Pulse fell from 90 to 60 in about half an hour, with increasing drowsiness (60 grains), 21.
In large doses, within safe limits, the pulsations are not reduced in number proportionately to the size of the dose, but the effect is more prolonged, 13.
The pulse of the carotids could hardly be felt (after one hour and a half), 33.
Pulse of right arm (she had lain on that side) not perceptible; that of the left, small, thready (after twelve hours), .

NECK AND BACK. [200.]

A "singing sensation," which seemed to come from the back of the neck, or from the medulla oblongata (1/2 ounce daily), 14.

EXTREMITIES IN GENERAL

Jactitation of the limbs, 44.

SUPERIOR EXTREMITIES

The blood had settled under the finger-nails, and there were purple spots on the side on which she had lain (after twelve hours), 50.
Muscular pains, chiefly felt in upper extremities, 29.

INFERIOR EXTREMITIES

Not merely leg-weakness, but some want of co-ordinative power, 14.
Finally, on rising one morning, he found his legs suddenly give way under him, was unable to stand or walk, and was obliged to get into bed again; this attack fortunately passed off in the course of the day, but left behind it great nervous depression and general weakness, accompanied with a feeling of utter vacuity of mind and inability to concentrate the attention upon anything, 39.
Sensation and motion paralyzed in both legs (lasted one week), 48.
Spells of feeling as though the legs were asleep (after four hours), 6.
Acute wandering pains in lower limbs, especially in calves of legs, occurring many weeks previous to cessation of Chloral; had a feeling, at times, on putting his feet to the ground in the morning "as if his legs were all in a mash," as if "he could not distinguish clearly between one part and another," 39.
Leg.
Sat suddenly bolt upright in bed, and complained of agonizing cramps in the legs, a feeling of suffocation, of swimming in the head, and of absolute inability to co-ordinate the movements of the lower extremities (after one hour and a half), 22. [210.]
On waking at 10 A.M., found to his horror that his legs were paralyzed from the knees downward; all the rest of the body was in a normal condition; this paralysis wore off in the course of the day (second day), 54.
Dull aching pain in calves of legs, at times running down into foot; sense of fulness of skin, with throbbing (after four hours); the severity of the pain lasted for about an hour and a half, when it gave way to a dull steady leg-ache, not very severe; it returned next day, more severe, 6.

GENERALITIES

Objective.
Literally, she resembled a living skeleton; appeared in a maudlin, semi-narcotized condition, and was only temporarily roused to consciousness by loud and repeated questionings; when roused, her answers were incoherent, her manner wild and uncertain, evincing altogether a state of mind closely bordering upon idiocy, 36.
In several parts of the field of the microscope, besides garnet-colored amorphous particles, a number of red-colored globules (double the diameter of white corpuscles, and many smaller) were seen; some of these were dark-red, 42.
Almost jumping and springing, he changed from one bed to another (soon), 27.
With very great muscular agility, he was steady and sure, and with great talkativeness his speech was correct (soon), 27.
Was observed to grow quiet, his eyelids drooping (after five minutes), 35.
Inaptitude for exertion, 29.
General state one of great depression (20 grains thrice daily), 15.
Became unaccountably depressed and very weak, especially in the lower limbs, this weakness increasing until he was compelled to give up his daily walks from sheer inability to put one leg before the other, 34. [220.]
Marked decubitus, with not merely indisposition, but at times manifest incapacity for exertion, 36.
Utter prostration of muscular strength, the limbs extended, the head low, and he had at times the aspect of impending dissolution, 44.
Lipothymia (especially on second or third day), 43.
Getting restless (after thirty minutes), 1.
Has become restless (55 grains, after twenty-five minutes), 2.
Most extreme restlessness (3 drachms, after ten minutes), 19.
Subjective.
Marked cutaneous anæsthesia (two cases, 60 grains), 21.
Completely and profoundly anæsthetized (after forty minutes), 35.
The feeling of muscular languor was so decided after each dose as to call for special remark, 40.
Frightfully severe pains, particularly about the joints, worse in moist and cold weather; the pains very strictly resemble the analogous sufferings which are (somewhat rarely) produced by chronic alcoholism; they do not run in the course of the nerves like neuralgia, nor are they exactly in the joints, like articular rheumatism; they seem to the limb, the finger, etc., immediately above or below a joint (1 ounce), .

SKIN

Objective. [230.]
A diffuse inflammatory redness over the whole body, so that it was thought advisable to isolate the patient; in ten hours this redness had disappeared, 15.
Eruptions.
Smooth, bright scarlet eruption over whole body (face, limbs, etc.), 48.
Four ounces of wine were sufficient to induce the chloral-rash (30 grains), 32.
A scarlatina rash broke out over the whole body, accompanied by fever and tenderness of the skin, and was followed by desquamation, 31.
The tendency which the use of Chloral produces to fluxionary hyperæmias, with increased and strengthened heart action, is first and most considerably manifested in the head, an intense erythema occurring, at first in spots, but afterwards more diffusely, and the vessels being dilated. In the more pronounced forms, the erythema extends downwards to the trunk, and becomes general, in which case it seems to follow, by preference, the course of the larger nerve-trunks. This choral-rash remains latent until set going by some stimulus to the vascular system, but then appears in an intensity and rapidity which are proportioned to the existing current of (general) choralization, 49.
On the ninth day of treatment, a rash appeared in the form of red spots which soon became confluent. On the twentieth day, the temperature and pulse rapidly rose to a febrile pitch; three days later, the temperature had reached 106.7°; large and repeated doses of Quinine were given without result, and baths had only a temporary effect. Œdematous swelling of the face, cheeks, eyelids, and ears now set in. During the whole course of the disease, the skin, so far from returning to its natural appearance, was the seat now of impetiginous, now of moist, and now of scaly eczema and ichthyoses, so that the process of desquamation, instead of being short as in the acute exanthemata, occupied many weeks, during which great sheaths of epidermis were cast off from all parts of the body. The profound lesions of the skin-nutrition were evidenced in the later stages by a remarkable shedding of the hair, and a gradual falling off of all the nails of the hands and feet. The affection of the skin was accompanied by a similar one of the mucous membranes, first of the intestines, which kept up watery diarrhœa in spite of medicines, and then by a similar affection of the conjunctiva and the bronchi. From the sixth week of the disease onwards a series of large abscesses formed on both arms over the shoulders and armpits, which secreted a considerable quantity of pus. Whilst these phenomena were occurring, there had been for eight weeks a continuous fever, occasionally remitting, and then again running up to a temperature beyond 104°, .

This hyperæmic condition of the skin was extraordinarily intensified immediately after the ingestion of the smallest quantity of wine, beer, or spirits, and was accompanied invariably with palpitation of the most distressing character , both lasting for about two hours; the excessive hyperæmia disappearing last of all from the forehead in curiously well-defined patches, 38.

First, erythema of the face, and later a papular rash on the arms, with red bases. In some, nettle-rash occurred (60 grains, daily), 32.
On the fourth day, a redness was developed on the skin of the chest and shoulders, which did not vanish on pressure; on the sixth day, the eruption had extended over the whole trunk and limbs, livid spots and deep red patches alternating. On the eleventh day, the petechial eruption was diminished on the chest and abdomen, the spots were yellowish, with patches of white skin between them. On the fifteenth day there was a sort of general desquamation; fissures of the skin over the sacrum and in the neighborhood of the joints (20 grains, thrice daily), 15.
Erysipelatous inflammation of the integuments of the fingers, with desquamation of the cuticle, and ulceration around the border of the nails (four cases), 46.
Subjective.
Intense irritation and itching of skin, preventing sleep at night, 16.

SLEEP AND DREAMS

Lies quiet; is gaping (55 grains, after six minutes), 2.
Inclination to drowsiness, 12.
For three weeks there was felt a painful sense of drowsiness, 19.
Drowsiness came on in a quarter of an hour, followed by natural sleep, which began forty-five minutes after taking. Sleep continued in one case for two hours and a half, without waking, and an hour and a half at intervals afterwards. In the other case, with the same, amount, sleep only lasted one hour and a quarter (45 grains), 21.
Sleepiness (10 grains), 40. [250.]
Very sleepy in evening, and retired early; did not feel refreshed on waking, next morning, 9.
Sleep (1 scruple), 40.
Went to sleep (soon after), 50.
On being brought back to bed, he at once went to sleep, passed the night quietly, and continued in a drowsy state all next day (60 grains), 21.
The symptoms having continued from the time of taking, 11 P.M., till 6 in the morning, the subject, apparently from sheer exhaustion, became quiet and fell asleep, and slept for two hours, when he awoke with a most violent headache, 19.
Without any trouble he fell asleep as soon as he laid down. Sleep quiet, natural, not disturbed by any dreams or hallucinations. Forcibly awakened, clear consciousness returned easily, and he replied promptly to any question. Left again to himself, he fell immediately again into his natural sleep, which lasted for ten hours, a thing which had not happened to him during his whole life, 53.
Sleep, on each occasion, occurred within half an hour of taking, and continued for upwards of eight hours, the result being that of having passed a sound refreshing night's sleep, with no unpleasant after-effects, 28.
Sleep came on in half an hour, and continued for four hours. It was, however, somewhat interrupted, and the patient was roused and made to answer questions without much difficulty (75 grains), 21.
Fell asleep (after half an hour), and slept for two hours. Then she awoke with a scream, jumped out of bed and sat on the edge of it, semi-conscious. Recovered in five minutes, and was got back to bed, where she lay quietly for an hour, and then fell asleep again. In two hours more she awoke with much epigastric pain, 52.
In the first case, the patient did not go to sleep for two hours, and then only slept one and one-fourth hours. Whereas, the other fell asleep in an hour, sleeping heavily two hours, and at intervals for from two to three hours more (60 grains), . [260.]

FEVER

Chilliness. [270.]
Surface of body cool (after one hour and a half), 33.
Temperature 22.9 (after one hour and a half), 33.
Became "stone-cold" (soon after), 51.
Cold extremities, 44 ; (after twelve hours), 50.
Heat.
Temperature 36 (112°), before taking 37.2 (115°), 53.
Temperature 39.5 (after one hour), 33.
Temperature 36.8 at 9 and 10 A.M. (before taking); 37 (after one hour); 37.2 (after three hours); 37.4 (after seven hours); 36.8 (after eleven hours), 23.
Sensation of heat all over the body, particularly the face, 3.
Sweat.
Profuse sweating (especially on second or third day), 43.
A cold perspiration flowed from him, wetting his pillow and sheets (soon after), 51. [280.]
A singular dryness of the skin (1 ounce), 14.
Perspiration in large beads on the forehead (3 drachms, after ten minutes), 19.

CONDITIONS

Aggravation.
( Morning ), at 8 o'clock, feeling of fulness, etc., in head; on waking, pain in head.
( Night ), Sense of weight on chest.
( Open air ), Headache in occiput.
( Leaning forward ), Pain in eyeball.
( Alcoholic liquors ), Flushing of face; pulsation of arteries; rash on skin; erythema of head, etc.
( Lying down ), Headache in occiput.
( Sudden motion ), Pain in head.
( Movement ), Pain in frontal region; headache in occiput.
Amelioration.
( Eating supper ), Nausea, etc.

Chloralum

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