Clinical observations on hydrate of chloral as a hypnotic in typhus / by James B. Russell.

  • Russell, James Burn, 1837-1904.
Date:
1870
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Licence: Public Domain Mark

Credit: Clinical observations on hydrate of chloral as a hypnotic in typhus / by James B. Russell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tovcr, and passed into acute mania; the second case of the kind I have seen after typhus. Both cases went on, unchecked by treatment to a Jatal termination. The following sedative agents were employed from time to time in the present case. 1. tartar emetic, Tq grain; Battley, 5 drops; once, no effect; and once, half hour’s sleep. “• Tartar emetic, -j’j grain ; tiuct. digitalis, 5 drops; every 4 hours No effect. 3. Bromide of potassium, in drachm doses, repeated for three suc- cessive hours. Given on 4 occasions, with excellent effect on three, but no effect on one. 4. Battley, 10 drops ; chloric ether, 20 drops. No effect. 5. Blister to scalp; twice. No effect. Bee. 21a*.—Pulse, 124. Wild delirium for at least 24 hours. At 2.30 p.m, 20 grains of chloral given. 3 p.m.—Pulse, 116 ; soft. Sleeping soundly and naturally; fell asleep in 5 minutes after administration. 4 p.m.—Pulse, 108. Continues in same placid sleep. 5 p.m.—Pulse, 100 ; soft. Sleeping soundly. 6 p.m.—Pulse, 132 ; feeble. Just wakened, and as maniacal as ever. Dose of chloral. Mode of administration. Dangers.—My first cases proved conclusively, that for the class of patients under my care, 40 grains is a toxic dose. It produced depression and irregularity of the heart’s action. In my cases, all the benefits without the dangers of chloral were obtained with 20 grain doses for adults; 2 grains for an infant of 18 months ; 3 grains for two of 3 years ; 10 grains for children of 9 and 14 years. The drug was given in an ounce of water sweetened with half an ounce of syrup.* Children take the draught quite readily in this way, and like it. If not sufficiently diluted, the medicine is vomited, as in Case I., where 30 grains were dissolved in only half-an-ounce of water and syrup. When sufficiently diluted it may be borne by the most irritable stomach, as it was in Case X., in which nutrient enemata were required from obstinate vomiting, and yet the chloral was not rejected. The dangers of an over dose of chloral are mani- fest from the cases in which 40 grains were administered. The depressing action of chloral on the cardiac ganglia is then developed. For the sake of the prn-ity of the experi- ment, in some of my cases, all stimulants, and to some extent even food, were prohibited. This is, however, un- * This dilution is enough for the lessened sensibility of a fever patient, but, from personal trial, not for ordinary use.