Hydrate of Chloral. 
D. I). BRAMBLE, M. D., OF CINCINNATI, 0. Hydrate of Chloral. 
I). D. BRAMBLE, M. D., OF CINCINNATI, 0. 
When we think of the worth of our predecessors, and 
that the greatest blessing for which they prayed, was 
“Men’s Sana in Corpore Sana," 
we blush at our own inferiority, though the telescope of 
science has revealed a perfect panoramic view of the citadel 
of medicine. The long and wearisome journey to the Jor- 
dan disappeared amid the more inviting and pleasant acces- 
sions to medical science. 
Nature placed at our disposal in the Papaverum Somni- 
ferum, that noble principal, opium, that for countless ages 
relieved the suffering, soothed the smarting wound, and 
cased the stinging pain. Following in its wake came mor- 
phia, ether, chloroform, and chloral. 
It would be vain for us to travel up the stream of time, 
and seek for a brighter history, and more flourishing age of 
medicine than that which crowns our profession to-day. The 
blue mist of fable and superstition has long since faded, and 
we now stand upon a tried foundation stone. 
’Anatomy, Physiology, Chemistry, Botany and Microscopy, 
has assumed for medicine the morning of a vast and glori- 
ous kingdom, whose temple of fame will cope with the hand, 
of war, and accompany time through eternity. 
At no time since the days of JEsculapius, has there been 152 
Hydrate oj Chloral. 
as much interest displayed as marks medical pages to-day. 
Man seems cognate of his duty to man, and is establishing 
a therapeutical poAver, which no debt of gratitude can repay. 
Our profession, shining Avith the transports of love, the 
fullness of life, the heaven-kissing ecstacies of hope, is rising 
in its temple of relief, vast, all beautiful and sublime, to its 
full meridian height, never more to culminate—and around 
it avc should cling that it may be strengthened, so that by 
the touch of dissention it never can be shaken, but be per- 
mitted to rise and stand upon the topmost stone of the coli- 
seum a tAvin sister of immortality. 
Chloral.—(Hydride of Trichlorcetyle.) 
(Symbol. C2 II Cl3 O.) 
This body was discovered by Liebeg in 1832. It is the 
ultimate product of the action of chlorine upon Alcohol. 
(C2 II6 O.) 
Alcohol may be decomposed by heat, electricity and chlor- 
ine. Chlorine gas is rapidly absorbed by alcohol, imparting 
to it a yellow color, and causing considerable rise in the tem- 
perature, which may cause the liquid to take fire, at the same 
time the chlorine abstracts hydrogen, which is replaced by 
chlorine, thereby producing hydrochloride acid, or aldehyde, 
acetic acid or acetate of ethyl, or chloride of ethyl, and fin- 
ally chloral, owing to the amount of hydrogen displaced and 
chlorine supplanted. 
The alcohol, by the action of the chlorine, is first convert- 
ed into aldehyde, by the abstraction of 2 H, and the alde- 
hyde is converted into chloral by the abstraction of 3 H, 
which is replaced by the chlorine. 
If we take absolute alcohol, (C2 H6 O,) and pass chlorine 
through it until 2 H is displaced and supplanted by 2 Cl:, 
we would then have aldehyde (C2 H4 O,) thus:— 
C2 H6 O+ 2 C1=C2 H4 0+2 II Cl. 
If we then take the aldehyde and pass chlorine through Ohio State Medical Society. 
153 
it until 3 H Is displaced and 3 Cl supplanted, we will have 
chloral, thus :— 
C2 H4 0 + 6Cl=C2 H4 C10+3C1 H. 
If only II were abstracted from the alcohol we would have 
chloride of ethyl. 
C2II6 O-f-H C1=C2 II5 Cl+H2 O. 
If 4 II were abstracted and 4 Cl supplanted we would ob- 
tain acetic acid, (C2 II4 02), thus:— 
C2 II6 0+II2 0+4 C1=C2 H4 Oa+4 H Cl. 
Hence we see that by abstracting 2 H, and supplanting 2 
Cl, we obtain aldehyde and two parts of hydrochloric acid. 
And by abstracting from the aldehyde 3 H and supplant- 
ing 3 Cl, we obtain chloral plus three parts of hydrochloric 
acid. 
Chloral cannot, however, be obtained direct from the 
action of chlorine on aldehyde. It may be produded in the 
first instant, but is soon converted into other products. 
For the production of chloral from alcohol it is absolutely 
necessary that the alcohol be anhydrous, for if water is pres- 
ent some other product instead of chloral is produced. And 
even when chloral is made from absolute alcohol, there are 
other products accompanying it. 
Chloral is also produced by the action of chlorine on starch 
and sugar. To make chloral from alcohol, use a long stem 
glass to contain the alcohol, and pass the chlorine through it. 
For making chloral the chlorine should be made from com- 
mon salt, pulverized fine, peroxide of manganese and sulp- 
huric acid ( as this gives off chlorine more regular than hy- 
drochloric acid and manganese.) The chlorine gas should 
first be passed through distilled water to wash it, and then 
passed over dry chloride of calcium to dry it, and then 
through the alcohol. Remembering that the alcohol must 
be kept cool to prevent its igniting. 
At first the chlorine should pass through slowly, but after 
four or five hours it should pass through as rapidly as pos- 154 
Hydrate of Chloral. 
sible, or in other words, with great rapidity, for twenty or 
twenty-five hours, or until chlorine passes through pure. 
The alcohol assumes a yellow tinge, and gradually changes 
to a heavy syrup, which solidifies on standing for several 
days, and presents the appearance of a soft white crystaline 
mass, composed of hydrate of chloral, hydrochloric acid and 
undecomposed alcohol. 
This crystaline mass is the crude hydrate of chloral. 
Then take in volume one of crude hydrate of chloral 
and four of sulphuric acid, and agitate together until the 
crude hydrate of chloral is dissolved, or cut up—set aside— 
when in a few hours a thin, hard white stratum will form 
on the top. If this stratum should not form, the chlorine 
must be passed through the alcohol longer. If this hard 
stratum forms, lift it off, and to one part of this add five or 
six of pure sulphuric acid : apply heat and melt the crystal- 
ine mass, let it stand and rise again, then draw off with a 
pipette. Then distill over lime and remove the hydrochloric 
acid, and in this manner you obtain chloral pure, but not un- 
til you have repeated this process several times. 
Stadler obtained chloral from sugar and starch by distill- 
ing with hydrochloric acid and per oxide of manganese. 
Pure chloral is not known only as a chemical curiosity, it 
'being so difficult to prepare it without having water in it— 
lienee we use the hydrate of chloral and call it chloral. 
'Chloral is greasy to the touch, and will make grease spots 
on paper that will soon disappear. It has a peculiar, pun- 
gent odor, and excites a copious flow of tears; its taste is 
greasy and slightly astringent. It acts very strongly upon 
the skin, and might be classed among the escharotics. It 
has no acid reaction, even when dissolved in water, and will 
not precipitate a solutioii of silver. Chloral is readily dis- 
solved in alcohol and ether, and it will readily dissolve iodine, 
bromine, sulphur, and phosphorous, by the appliance of heat. 
The iodine solution presents a purple color. Ohio State Medical Society. 
155 
Chloral, with a small amount of water added, solidifies 
and forms a mixed mass of hydrate of chloral. (C2 II Cl3 
O-p112 O.) The boiling point of hydrate of chloral is 230° 
Fah.; it solidifies at 104° Fall., but an excess of water will 
vary the solidification. 
Pure chloral generally distills unchanged with pure sul- 
phuric acid, but if hydrate of chloral be heated with sulphuric 
acid part of the chloral distills over into the anhydrous state, 
and the rest is converted into chloralide, (C5 H2 Cl6 03) 
thus:— 
3 C2II Cl3 0+II2 0=C5 II2 Cl6 O3+3 II Cl f C O. 
Chloralide is insoluble. Nitric acid converts chloral into 
terchloracetic acid. (C2 II Cl3 02.) 
Anhydrous metallic oxides, such as baryta, strontia, lime, 
cupric oxide, mercuric oxide, and peroxide of manganese, 
have no general or specific action on chloral. But alkalies, 
either solid or aqueous, readily decompose chloral at ordi- 
nary temperatures, converting it into a formate and leaving 
a portion of chloroform, and the chloroform is also partly 
decomposed by the potassium, thus;— 
C2 II Cl3 O+K H 0=C II K 02+C II Cl3. 
The chloroform that has thus been liberated is now seized 
upon by the overplus of potassium and chloride of potassium 
is formed, and carbonic acid liberated, thus :— 
C II CI3+4 K II Q=C H K 02+3 K Cl+2 II2 O. 
Ammonia forms with chloral a peculiar compound that 
will reduce silver. 
Dr. Dumas investigated its chemical properties the second 
year after its discovery. Kopp, Wurtz and Regnault, also 
investigated its chemical properties, and it was placed among 
the.alcoholic products in common with aldehyde and chloro- 
form. Then for nearly thirty years this valuable chemical lay 
in darkness until Dr. Oscar Liebreich, who in searching for 
some way to liberate chloroform in the blood and produce 
a similar effect as by inhalations, commenced experiments 156 
Hydrate of Chloral. 
with this alcoholic product. It was ascertained that strong 
acids did not affect it. But if an alkali be added to a solu- 
tion of hydrate of chloral, it would split up into formic acid 
(C II2 02) and chloroform. The Tormic acid uniting with 
the alkali and forming a formate. 
If to a solution of hydrate of chloral caustic soda be added, 
the formate of soda is left and chloroform is liberated. This 
then led Liebreich to believe that if in the crucible, by ad- 
ding hydrate of chloral to an alkali, chloroform could be liber- 
ated, so in the human body if by adding hydrate of chloral 
to the alkalinity of the blood, chloroform could be liberated 
in the system and produce all the phenomena of inhalation 
of chloroform. 
If then any alkali be acted upon by hydrate of chloral as 
potassa, soda, or ammonia, it is changed into a formate, and 
chloroform is given off, and a portion of the liberated chloro- 
form unites with the potassa or soda, and forms a chloride of 
the alkali. 
But if any amount of an alkali be added, only an amount 
corresponding to the contributing equivalent will be con- 
verted into formate, and chloroform corresponding will be 
given off, while the excess of the alkali will remain, and vice 
versa, if more chloral be added than the combining equiva- 
lent of the alkali, the proportionate quantity of formate and 
chloroform will be formed, and the excess of chloral will 
remain unchanged. 
The fact of the evolution of chloroform from the uniting 
of an alkali with chlorine should be understood lest we 
combine an alkali with chloral in our prescriptions, and 
liberate chloroform long before the patient receives the pre- 
scription, and then instead of chloral he will swallow, the 
formate of the alkali, and the sad tale of sorrow to the 
Doctor next day is, “your medicine did me no good ; I didn’t 
sleep any all night long.” 
The chemical affinities of this newr agent needs to be Ohio State Medical Society. 
157 
thoroughly understood by physicians and druggists. Hun- 
dreds of our physicians have prescribed it, and reported up- 
on it. 
Its physiological and therapeutical action has been tested 
and investigated by many of our leading physiologists, such 
as Demarquay of France, I)rs. B. W. Richardson and J. R. 
Russell of England, Dr. Wm. Ilammond of New York, Da 
Costa of Philadelphia, and a retinue of others. It has been 
used iu experimenting upon nearly all classes o? animals. 
It has been used in hospital and private practice with good 
and with evil results. And like any chemical that is clothed 
in mystery, from its intricate formation and so susceptible of 
change: being used by highly educated medical men and by 
ignorant pretenders. By graduates and 11011-graduates. By 
regular physicians and quacks. 
Combining it with alkalies, acids, and saccharines—com- 
pounded by incompetent drug clerks, and given at random, 
so that to-day it has its laudations and detestations, and 
from the fact that its principal element is chlorine is evidence 
that it is highly susceptible of change—its affinity for other 
substances being so great. 
Chlorine itself being a virulent poison, and the great 
number of compounds that can be formed from oxygen and 
chlorine, from water and chlorine, was a mountain for physi- 
ologists to overcome, and in placing chloral among the highest 
of our therapeutical agents, we will always have to contend 
against its tendency to chemical change. That it is, when 
pure and handled with care, a great somnolent anodyne, 
possessed ot great therapeutical powers, we will not call in 
question. But that its destiny is to be to medicine what 
chloroform has been to surgery, we are not willing to admit. 
AVc have in this a great chemical agent, intimately in alli- 
ance with physiology, and in proportion to its greatness as a 
chemical agent so is its liability and minute susceptibility 
to chemical changes and its physiological actions will accord to 158 
Hydrate of Chloral. 
its chemical actions and be subject to as much change physi- 
ologically as chemically, and never can occupy that grand 
position to which Liebreich and Dumas ascribed to it. 
Until lately chloral has always been investigated only in 
an abstract theoretical point of view, and never was known 
as a therapeutical agent much less one of the most efficient 
and precious. 
Opening then before us in this day of modern light, and 
medical lore, with the veil of mystery still hanging before 
our eyes, is a held of inquiry and research, of which but 
little is as yet known, of the exact agencies and proficiencies 
of this novel drug. 
Freeing ourselves from the restraint of all schools and 
“ pathys,” and relying upon the chemical affinity as revealed 
in the test tube and crucible, as well as in the human body, 
we are called to investigate and place upon our therapeutical 
list a novelty that no doubt is destined to be as the waters 
of a second Jordan,-and cure all the ills to which human flesh 
is heir, and dare to almost stand face to face and grapple in 
a hand to hand contest with death. 
Heretofore chloral, as has been said, was considered in an 
abstract theoretical manner. But now it should be consid- 
ered in its general physiological actions. 
1st. All theoretical changes alluded to are not to be found, 
unless by the most minute and thorough chemist, and physi- 
ologically we will have but few changes, so that we can with 
some assurance of success predict a glorious future for 
chloral. 
2d. Chlorine with its great property of unstability in 
its separate state, has in chloral the form of great stability, 
owing to the components with which it is united in forming 
chloral, and thereby has less adaptability to physiological 
change in this form than any other. 
Then when introduced into the organism we need not be 
alarmed lest it should assume divers numbers of compounds, Ohio State Medical Society. 
159 
as it does in the chemists’ hands, for these changes are most- 
ly the finely worked-up discoveries of the chemist, formed 
only when certain minute proportions are made to exactly 
correspond. 
Experiments upon animals and man have been instituted, 
and from these we may derive some of the more accurate 
actions of chloral on the organism, and perhaps learn how 
to administer it with more advantage to the patient and less 
injury to our reputation. 
M. DEMARQUAY. 
(Communicated to the Academie des Sciences.) His ex- 
periments upon rabbits : 
“ I have experimented on a great number of rabbits, in- 
jecting into the cellular tissue of these animals from 20 centi- 
grammes to 1.20 gramme, without causing death in any of 
them; all in from fifteen to twenty minutes fell into a deep 
sleep. The duration of this sleep was between two and 
three hours, and however great had been the muscular resolu- 
tion and the depression of these animals, they all recovered. 
On the following day they were in a marvellously good con- 
dition. I have been enabled to make use of the same rab- 
bits in several experiments. 
The following appearances may be made out by attentively 
watching them. The ocular and palpebral mucous membranes 
are injected. The ears are vascularized in a manner quite 
remarkable, one would think these animals had undergone 
section of the great sympathetic, according to the fine experi- 
ments of M. Claude Bernard. 
There is no increase of temperature in the vascularized 
parts, sensibility seems to be quickened and their faculties 
exalted. The slightest pinch of the tail or ear, excites un- 
ruly movements and whining cries, such as are not heard 
when a healthy animal is irritated in the same manner. The 
pulse, under the influence of chloral, becomes extremely fre- 160 
Hydrate of Chloral. 
quent, and the animal temperature of the body is lowered. 
Frequently when narcotized by chloral they exhale by their 
nostrils the odor of this substance, which would lead one to 
suppose that it is not decomposed completely in the blood, if 
it be at all decomposed in the blood. (It seems that Demar- 
quay doubts its decomposition in the blood.) 
If one opens during life the bodies of animals narcotized 
by chloral they will find the abdominal viscera congested, 
the vessels of the messentery turgcscent, the mucous mem- 
brane irritated, particularly that of the trachea. The cen- 
tral nervous system, the brain and cerebellum and their 
membranes, are strongly injected, as well as the cord and its 
membranes. But on account of the small size of the sympa- 
thetic I have not been enabled to recognize any change n 
color. 
Fishes.—Fish are readily narcotized by hydrate of 
chloral. By mixing chloral with the water in which they 
are swimming they inhale it slowly, and at last fall asleep. 
A large carp was put to sleep by Dr. Sedgwick with a sub- 
cutaneous injection of 5 grains of the hydrate of chloral. 
The breathing is regular and gentle, altogether oblivious 
and insensible. 
To insure their recovery they must be placed in good fresh 
water, so that the eliminated products may be quickly carried 
away. 
Mice.—Mice are easily and readily narcotized by chloral. 
A half grain being sufficient to put a mouse weighing an 
ounce to sleep, and when asleep resembles a dormouse in a 
state of hibernation. They pass into sleep without any ex- 
citement, and recover without any baneful symptoms. 
Frogs.—The poor frog has to suffer, and though he would 
gladly go “chug” into his watery home, yet insatiate man 
gathers him up, and subjects him to every torture and ap- 
pliance that human ingenuity can invent, and then has him 
nicely prepared for his own stomach’s sake. Ohio State Medical Society. 
161 
Frogs are quickly and easily narcotized by chloral, a half 
grain being sufficient to seal his majesty in sound sleep, and 
three-fourths of a grain generally causes the largest and 
oldest frog to “sleep the sleep that knows no waking.” As 
soon as the chloral begins to take effect, his head drops, his 
limbs are relaxed, his eyes close, and he quietly sinks into a 
profound stupor. His motions are cataleptic, his limbs re- 
maining in whatever state they are left. The sleep in a frog 
will last for a period of 20 hours. 
Take two frogs, give one a large dose and the other a 
small one, the one with a large dose will lay, with impercep- 
tible breathing and seemingly dead, and may possibly be 
dead, while the one that was treated to a smaller will lay 
calm and breathe softly, and in about twenty-four hours, at 
a moderate temperature will wake up. They have no sensi- 
bility when under the full influence of chloral. Every 
function of life but the circulation seems stopped. And 
when sleeping so soundly as to pass for dead, place the 
web of the foot under the microscope, and there is seen the 
circulation going on in the most perfect manner.” 
There seems to be no sensibility. Then we would have: 
1st. Deep sleep, quickly produced and if carried far 
enough, fatal anaesthesia. 
2d. Chloral acting without any excitement. 
3d. We find waking up without any bad effects—or more 
like awakening from a natural sleep. 
4th. In fatal doses the nerve power of the heart is the 
last that suffers, and upon examination we find the auricles 
and ventricles filled with blood—as if life had been stopped 
by paralysis of the heart, paralysis seeming to take place 
first in the ganglionic cells of the brain, next in the gang- 
lionic cells of the spinal cord, and lastly in the ganglionic 
cells of .the heart. 
This then leads us to seek for the action of chloral. We have 
seen that when the hydrate of chloral is treated with an alkali 162 
Hydrate of Chloral. 
it is resolved into a formate and chloroform is liberated. The 
blood is an alkaline fluid. If then the hydrate of chloral 
be introduced into the organism, every small particle of it 
will unite with and consume a corresponding quantity of 
alkali, and the decomposition of chloral will be effected 
only as the blood furnishes an alkali. 
Chloroform being liberated in the blood, requires only the 
smallest space of time to be conveyed to the ganglionic cells 
of the cerebrum, when the minutest quantity of chloroform 
would then take on its first action in the ganglionic cells 
of the cerebrum,* and as the chloroform increases, the action 
increases and extends to the ganglia of the spinal cord, 
and lastly it extends to The ganglionic cells of the heart. 
The first action corresponds with the slowest possible elimi- 
nation of chloroform, and the removal of chloroform from 
the body is not by its being converted into carbonic acid and 
hydrochloric acid, but passes off as pure chloroform. 
Dr. Richardson says he detected the odor of chloroform 
ip the breath of animals sleeping under the influence of 
chloral. This corresponds to the researches of Dr. Snow, 
upon chloroform, who showed clearly that its extrication was 
unaltered. Chloroform* which is the active agent produced 
by giving chloral, is most beautifully described by Dr. Simp- 
son to the Medico-Chirurgical Society of Edinburg, on Nov. 
10th, 1847. 
As to why we use chloral in preference to opium, might be 
answered in the words of Dr. Snow : “ For the same reason 
that you use phosphorous matches, instead of tinder box, an 
occasional risk never stands in the way of applicability.” 
He no doubt thought of the Portland fire that was caused 
by matches, and yet every man, woman and child, still uses 
matches. 
The organ most frequently smitten by chloroform or by 
giving chloral, is the heart. The lungs are affected by the 
*Dr. Richardson, Medical Times and Gazette, Oct. 30th and Nov. 6th, I860. Ohio State Medical Society. 
163 
chloroform that is formed coming in contact with the pul- 
monary branches of the pneumogastric nerve, and they suffer 
from paralysis of these branches. Chloroform first affects the 
ganglia of the cerebrum, then the ganglia of the cord, and 
lastly the ganglia of the heart. The heart is affected last 
no doubt on acount of its great self-sustaining power. The 
heart, fed by the coronary arteries, receives the first blood 
thrown from it at every stroke, and since, as was shown, the 
slightest quantity of chloroform first affects the ganglia of 
the cerebrum, and the next larger quantity the ganglia of 
the cord—the last and greatest quantity would exert its in- 
fluence upon the heart. 
If then the blood by which the heart fed not only the whole 
body, but itself, is normal, then normal blood would supply 
the heart, but if the blood should contain chloroform, and 
thereby be abnormal, the heart would be the organ that 
would receive the first injury, and when this abnormality 
was sufficient to produce death, we would then have the 
nerve power of the heart smitten lastly by this agent. 
Birds were next taken. 
Pigeons are readily narcotized with a small amount of 
chloral, from one and a half to two grains. 
From the experiments of Dr. Ilichardson no excitement 
preceded the sleep, but the birds, as after chloroform, usually 
showed signs of nausea as they became drowsy. The 
character and degree of sleep varying with the dose; one 
grain and a half producing drowsiness in ten or twelve 
minutes; deep sleep in an hour, and two or three hours 
of interrupted sleep—2 grains produced deep sleep in 
ten minutes, with perfect insensibility for 26 minutes, and 
interrupted sleep for some hours. Two and a half grains 
produced complete anaesthesia in 20 minutes that lasted one 
to two hours. 
With these sized doses they generally wake with slight 
reflex movements or with 21 grain doses with tremors. Five 164 
Hydrate of Chloral. 
grains produced complete insensibility in 16 minutes, with 
convulsive movements and death in 50 to 60 minutes. 
Seven and a half grains produced insensibility in 5 minutes, 
and death in 47 minutes, preceded by convulsive move- 
ments. 
In all these cases the odor of chloroform was distinctly 
perceptible in a few minutes after administration. In every 
bird there was a decrease of animal temperature, and the 
temperature varied according to the amount given. 
Recapitulation of the experiments on pigeons. 
1st Pigeon 1\ grains, deep sleep in one hour, no insensibility. 
2d “ 2 “ “ “ 10 minutes, insensibility for 2G 
minutes. 
3d Pigeon 2J grains, complete anaesthesia in 20 minutes, insensibility 
for 1 to 2 hours. 
4th Pigeon 5 grains, complete insensibility in 16 minutes, death in 50 
to 60 minutes. 
5th Pigeon 7 grains, complete insensibility in 5 minutes, death in 47 
minutes. 
\\ grains reduced temperature 2° Fah. 
2 u u (i 5° li 
ry u u u go u 
•J U ii K JQO U 
Dr. Oscar Liebreich, in bis communications to the Berlin 
Medical Society, gave its chemical history and chemical 
changes, and then the change in the organism together with 
its effects on animals. 
A small dose, l-10grammes, produced narcosis in a very 
young kitten. The animal sleeping quietly, did not mani- 
fest any of the excitant stage of chloroform anaesthesia. 
He produced hypnosis of nine hours duration in moderate 
kittens by injecting grammes of hydrate of chloral. 
His experiments upon frogs seemed to show more regu- 
larly and more clearly the effects of chloral. (When the 
ganglia of the cerebrum were effected.) The animal allow- 
ed himself to be placed in any position and so remain, (pos- 
sessing reflex excitability.) Then came on a stage, (when the 
ganglia of the cord were effected,) when the reflex excita- Ohio State Medical Society. 
165 
bility was lost, and if a fatal dose had not been employed 
the frog would return to his natural condition. But if a 
fatal dose was administered the heart would be found gorged 
with blood as though dying from heart paralysis. 
In his communication he recommends the hydrate of 
chloral for neuralgia and rheumatism, for convulsive cough 
and tetanus, for acute mania, delirium tremens, gall stone, 
and for removing the pains of surgical operations. We will 
now quote from the researches of Dr. B. W. Richardson, of 
London. 
Dr. Richardson tested the virtues of hydrate of chloral 
on fishes, frogs, mice, birds, and rabbits, and then adminis- 
tered it to man and recorded the same symptoms (so far as 
they had been traced) as in the lower animals. Long sleep, 
lasting for several hours, has resulted in men and women 
from one dose, varying from 20 to 60 grains, and men in the 
frenzy of acute mania have been brought into quiet sleep by 
one or two drachms. The sleep is gentle, with no symptoms 
of distress, and leaves no serious evil behind. 
In every animal, from the lowest to the highest, the sleep 
is induced, not merely without pain, but seemingly with 
great pleasure, assuming their natural manner, the rabbit 
arranging himself, and the cat purring as they pass into calm 
and oblivious repose. 
Weight seems to influence the effect—an animal weighing 
3 ounces requiring 1 grain to be brought fairly under its 
influence, and the influence varies as the dose is less than 1 
grain. In the human subject we must take into consideration 
not only the size and weight, but obesity, leanness, natural 
habit, and actual state of body in respect to sensibility. 
Though Dr. Richardson contends that “ the quantity of the 
dose should vary with the weight of the body/’ we feel like 
assuming altogether a different theory for the gradation of 
the dose, to-wit, the dose of the hydrate of chloral should 
correspond to the alkalinity of the blood, since it is by the 166 
Hydrate of Chloral. 
evolution of chloroform from the contact of the chloral with 
the alkali of the blood. 
The less alkali the less chloroform would be generated 
and the more alkali the more chloroform would be generated, 
hence the greater the effect, but with a small amount of 
alkali the more chloral should be given, so that a greater 
amount of carbonic acid would be generated in the second 
action, and the result desired would be approximated to. 
But with a great amount of alkalinity it is very easy to see 
that less chloral is required, or too great a quantity of chlo- 
roform would be generated. 
Dr. Richardson then gives the following summary: 
1st. Deep and prolonged narcotism can be safely produced 
by the hydrate of chloral. 
2d. During a portion of the period of narcotism there 
may be complete anaesthesia, with absence of reflex action, 
and a condition in which every kind of operation fails to call 
forth consciousness. 
3d. During the narcotism there arc intervals of apparent 
exalted sensibility. 
4th. In the transition from drowsiness to stupor, there 
is no stage of muscular excitement, but in birds there is 
vomiting, as is common in the same animal in the second 
stage of narcotism under chloroform. 
5th. During narcotism produced by this substance, there 
is invariably reduction of temperature. 
6th. The hydrate produces muscular relaxation, which 
relaxation extends to the muscles of volition and alike to the 
iris and muscular arterial system. From the condition of 
the muscles after death, we may infer that this paralysis is 
in part due to change within the muscular structure 
itself. 
7th. The action of this substance on the nervous system 
is primarily on the sympathetic ganglia, afterwards on the 
cerebrum, and finally on the heart. Ohio State Medical Society. 
167 
8th. Recovery when it takes place is followed by no bad 
resnlts. 
9th. In fatal cases the functions destroyed are—1st, The 
cerebral; 2d, The voluntary muscular; 3d, The respiratory ; 
4th, The heart. 
10th. This substanee, in small proportions, arrests in 
some degree the coagulation of the blood, and in large quan- 
tities stops the coagulation altogether. In large quantities it 
also destroys the blood corpuscles, and produces general des- 
truction of the blood ; but the dose required to produce ex- 
treme narcotism need not be so large as to lead to serious 
derangement of the blood. 
11th. The phenomena observed correspond with those 
observed under chloroform, and the balance of evidence is 
that they are the result of the action of chloroform. 
12th. Summing up the facts, the hydrate of chloral pro- 
duces sleep, removes sensibility, reduces the animal tempera- 
ture, and causes extreme muscular relaxation. 
Taking these facts as our guide we may reasonably put it 
to the test for the relief of various diseased states and condi- 
tions. 
Views of the editor of the London Lancet, Oet. 2d,1869 : 
“The idea that the hydrate of chloral is intended to 
supersede chloroform, bichlorite of methylene, ether, or the 
other volatile anaesthetics, as an agent for removing pain 
during the performance of surgical operations, is an error. 
Whatever may have been the hopes of the distinguished 
Leibreich himself on this point, when he originally thought 
of employing the agent, they have not been realized. Nor 
has it been put forward as the rival of the agents named for 
surgical anaesthesia. It is as the rival of opium that 
hydrate of chloral demands our consideration. Speaking 
simply of its effects on the body, and leaving out of view 
the theory of its action, and its supposed decomposition 
within the organism, we may state definitely that the hydrate 168 
Hydrate of Chloral. 
when administered in an eftioient dose, (a drachm is not an 
immoderate dose for an adult,) produces on man and inferior 
animals a kind of stupor or sleep, which may be made to 
extend over five, and even over seven hours, with compara- 
tive safety. 
The stupor is sometimes preceded by nausea, and in birds 
it is always preceded by vomiting. It is attended with great 
muscular prostration, and with a decrease of animal tem- 
perature. During the period of stupor there is an interval 
of perfect insensibility to pain; but the interval is short, 
and for the greater part of the period the sensibility is either 
natural or exalted. This fact of the exaltation of sensibility 
which was especially dwelt upon by the reporter at Exeter, 
has been confirmed by the researches of Demarquay, of Paris, 
whose paper was noticed in the Lancet. It is a fact as 
curious as it is important; and indeed the whole subject is one 
of interest.” 
But, as Ave have already intimated, the first question to be 
made out in practice is, Avhether hydrate of chloral can be 
used for sustaining sleep in the same class of cases as those 
in Avhich Ave iioav administer opium. We see that the editor 
speaks of tAAro important actions: the first, is chloral the rival 
of opium or is it not. Second, does it exalt the sensibilities 
or not. 
VieAvs of Edward H. Clark, M. D., Prof, of Mat. Medica 
in Harvard University: 
After giving the history of its discovery and chemical 
affinities, he says, “A knoAvdedge of the physiological action 
of the hydrate of chloral on man is an indispensible guide 
to its use in disease. We do not yet comprehend this action 
completely, but Ave knoAV enough of it to aid us materially 
in its chemical administration. The points of greatest im- 
portance to the practioner are its absorption, its elimination, 
the changes Avhich it undergoes in its progress through the sys- Ohio State Medical Societi/. 
169 
tern, and its action on the system from the period of absorp- 
tion to that of complete elimination. 
Hydrate of chloral is readily absorbed by the mucous sur- 
faces of the stomach and rectum, and also by cellular tissue. 
It is easily and quickly absorbed by the stomach if largely 
diluted, and moderate doses may be absorbed in a few min- 
nutes. Fifteen grains were administered to a patient, who 
fell asleep in ten minutes, from which it is fair to infer that 
the whole or nearly the whole of the quantity given passed 
from the stomach into the blood within that space of time. 
The stomach appears to be capable of passing into the blood 
any quantity of hydrate of chloral that may be put into it, 
provided it is pure and sufficiently diluted. Hence any 
quantity of it may be given at a dose, so far as the stomach 
is concerned, that it is wise to administer. 
PROGRESS THROUGH THE SYSTEM. 
Hydrate of chloral goes from the stomach into the blood 
unchanged. In the blood it meets with an alkali, and ex- 
periments show that chloroform is evolved in the system 
the same as out of the system. The amount of chloroform 
thus given to the blood is proportionate to the quantity of 
chloral absorbed, and also proportionate to the alkalinity of 
the blood. 
The total quantity of chloral is not immediately decom- 
posed into chloroform. The chloral mixes with the blood, 
and passes with it to every part of the organism, and as 
it circulates, continues to yield chloroform until it is exhausted. 
In cases of fever of a low type, such as typhus and typhoid 
fever, when the blood is highly charged with ammonia, it is 
then in a state to extract chloroform from chloral more 
rapidly than when it is less alkaline. 
Under such circumstances a given dose of hydrate of 
chloral should produce its physiological action more rapidly 
and powerfully than in ordinary doses. 170 
Hydrate of Chloral. 
Elimination.—Most, if not all, of the hydrate of chloral 
is eliminated from the system in the form of chloroform, into 
which it has been changed. 
Its Action on the System.—Hydrate of chloral, while 
in the system, affects especially the blood, the cerebro-spinal 
axis, the heart and arteries, the muscular system and tem- 
perature. 
Therapeutical Indications.—The therapeutic indica- 
tions and contra indications which these physiological phe- 
nomena point to are obvious. Hydrate of chloral may be 
given so as to produce sleep, diminish sensibility, allay irri- 
tation, slow the heart, relax muscular tissue, lower animal 
temperature, devitalize the blood, cause anaesthesia, and 
destroy life. Part of these phenomena have a therapeutic 
value, and part are toxic. They may be arranged in two 
groups. 
Therapeutic Group.—Sleep; diminished sensibility; 
diminished irritation ; muscular relaxation; contraction ot 
arteries. 
Toxic Group.—Slow or irregular pulse ; complete anaes- 
thesia; altered blood globules; great diminution of tempera- 
ture; great muscular relaxation ; death. 
In the administration of chloral, it is its therapeutic phe- 
nomena and not its toxic that we wish to obtain. This can 
be accomplished by proper attention to the purity of the 
article and mode of administration. 
As chloral has been used in a variety of diseases, and in 
various doses, with various effects, and even with no effect, 
we will submit a number of cases before we draw our con- 
clusions. 
CASES OF NEURALGIA. 
Case 1. By Dr. T. Spencer Wells, Medical Times and Ga- 
zette, Sept 18, 1869. Sciatica, two grains of morphia given 
subcutaneously were necessary to procure sleep. Thirty grains 
chloral given procured best night’s rest she had enjoyed. Ohio State Medical Society. 
171 
Same dose repeated following night with like result. Sub- 
sequently increased dose to 40 grains to insure perfect rest, 
which was always obtained except on one occasion, when, on 
account of a severe relapse, 4 grain of morphia and 1-60 grain 
atropia was injected two hours before administration of 
chloral. Drug continued for three weeks. 
Case 2. Lady: Occipital Neuralgia; thirty grains of 
chloral produced no hypnotic effect; the patient suffered so 
much from burning pain in the throat and stomach that she 
declined further experiment. 
Case 3.—By J. C. Ogilvie Wills, M. D. Facial neural- 
gia, treated by sub-cutaneous injection of l of grain of mor- 
phia at seat of pain, with instantaneous relief; this was 
repeated for four days, when he was complaining much of 
want of sleep, when 30 grains of chloral was administered. 
In less than seven minutes he fell into a calm slumber, which 
lasted for eight hours. The chloral was repeated each night 
until the patient was convalescent. 
Case 4.—By J. C. O. Wills, M. D. Most distressing case 
of neuralgia, where hypodermic injections of morphia and 
atropine, bromide of potassium in small doses, and opium 
in large doses failed to induce sleep ; thirty grains of chloral 
was given ; this also failed. Fifteen minutes after 30 grains 
more were given. Five minutes later the patient was sound 
asleep, and did not wake for seven hours. On the following 
night .*>j was given; sleep followed immediately, but not of 
as long duration. 
For the ten following nights, 5ij were given. Sleep in- 
variably came on within five or six minutes, duration vary- 
ing from eight to twelve hours, and the patient awoke on 
every occasion without experiencing any of the unpleasant 
after effects some have ascribed to this drug. 
Case 5.—By J. M. Palmer, M. D., Dalton, Ohio. Lady : 
victim of paroxysmal neuralgia of head as well as severe 
attacks of sciatica. Best known remedies gave only temporary 172 
Hydrate of Chloral. 
relief, often had to resort to chloroform during attacks of 
hemicrania. 
During one of her accustomed attacks gave 10 grains of 
chloral; in an hour after free from pain, and quietly sleep- 
ing. At 1 a. m., three hours after, felt some pain; gave 10 
grains, after which she slept till morning. At 10 A. M. found 
her suffering intensely, gave 10 grains; waited an hour, no 
relief; then repeated same dose, still no relief; then gave 16 
grains; in an hour patient was relieved, and slept until 
night. At 8 p. m. pain returned; gave 20 grains, which 
had the desired effect; patient slept till next morning; has 
had no return. 
Case 6.—By G. R. Patton, M. D., of Cincinnati, Ohio. 
Neuralgia of head twelve years standing; attacks periodical, 
lasting four or five days; medication had little influence in 
limiting duration of disease. In one of her attacks, at its 
greatest intensity, administered 3) grains of chloral per rec- 
tum, from this she slept some. In two hours 30 grains more 
were given in same manner, and in half an hour she fell 
into a tranquil and uninterrupted sleep of six hours. When 
she awoke had no pain. 
Case 7.—By Dr. IT. A. Spencer, of Erie, Pa. States in 
Medical and Surgical Reporter, page 401, May 14th, 1870, 
that he used chloral in one case of neuralgia4without any 
good effect. He gave 30 grains in divided doses, his patient 
only slept half an hour; he repeated the medicine, the pa- 
tient getting no rest or sleep until morphia was administered. 
Case 8.—By C. E. H. Rogers, London Lancet, May 28th, 
1870. Relates a case of neuralgia in the supraorbital and 
intercostal regions, relieved by chloral, but was followed by 
intense headache, that only ceased on the suspension of 
chloral. 
Case 1.—Prof. Verneuil submitted to the Academy of 
Sciences, of Paris, the case of a young man who suffered 
CASES OF TETANUS. Ohio State Medical Society. 
173 
from tetanus in consequence of a crush of extremity of right 
radius. The patient took chloral for a week, the dose vary- 
ing from 90 to 180 grains per diem. 
Case 2.—Mr. Spencer Watson, London Lancet, July 
16th, 1870. Woman 41 years : traumatic tetanus. Chloral 
was given in intervals of four, six, and eight hours, in doses 
varying from 30 to 60 grains, for fourteen days; on one or 
two occasions coma seemed to be impending, the dose was 
omitted, but restlcsness and lividity of the face having come 
on, with slight opisthotonos. During these intermissions the 
full dose was resumed, and these symptoms subsided. Bowels 
acted only after repeated doses of croton oil. Pulse varied 
from 70 to 120, temperature from 995° to lOOf5. The jaws 
can now be opened and swallowing is quite easy for soft 
solids. 
Case 3.—Under the care of Mr. Moxhay, Royal Berk- 
shire Hospital, L. L., Aug. 27th, 1870, page 293. Trau- 
matic tetanus in man, act. 25, occurring 10 days after injury; 
treated for four days with calabar bean, but without effect; 
then gave thirty grains of chloral, which produced five 
hours sleep. On waking spasms were less violent, and 
seemed altogether better. Dose repeated again, producing 
sleep; chloral continued for three days; 30 to 40 grains 
night and morning, always with relief to spasms, and followed 
by sleep, lie then died from haemorrhage from sloughing of 
vein. 
Case 4.—Under care of Mr. May. Traumatic tetanus. 
Boy : aged 13; treated first with calibar bean, 3 grains every 
3 hours; difficulty increasing; spasms so violent as to require 
artificial respiration. Then gave with difficulty 30 grains 
of chloral which put him to sleep, slight spasms occurring 
during the night; after this 20 grains were administered per 
rectum once or twice daily, and always with the effect of 
relieving spasms and giving rest. On the 39th day had 174 
Hydrate of Chloral. 
scarcely any spasms; the enema of chloral continued. One 
month later he was discharged well. 
Case 5.—Under care of Mr. Birkett, Guys’ Hospital, 
L. L., Sept. 24, 1870, page 534. Traumatic tetanus. Man: 
aged 26. Gave 30 grains of chloral every 4 hours for two 
days; continued to get worse; gave then in the place of 
chloral 1 grain of opium every three hours, which was con- 
tinued for four days, patient getting worse. Then resumed 
chloral; gave first dose 5i, followed by 15 grains every two 
hours; following day a little better ; slept several hours. 
This was continued for six days ; then increased the dose, 
giving 25 grains every two hours for three days. Then di- 
minished to 15 grains every two hours; from this time medi- 
cine was given less frequent, and in three weeks chloral was 
left otf. 
Case 6.—Great Northern Hospital, under care of Mr. 
Spencer Watson, L. L., Sept. 24th, 1870, page 434. Trau- 
matic tetanus. Female: aged 41. This patient was kept 
more or less under the influence of chloral by giving 40 
grains every four hours during the day, and 60 every six 
hours at night, often sleeping continuously for eight or ten 
hours, and even during the day remaining so profoundly un- 
conscious that she was only aroused with difficulty. The 
chloral was then discontinued with a view of ascertaining 
how far the relaxation of the jaws already obtained would 
become permanent. Oifthe following day patient became so 
violent both in her language and demeanor that it was 
necessary to put her in a straight jacket. Chloral was again 
given in 40 grain doses, with the effect of calming the ex- 
citement; this was then continued for nine days, then discon- 
tinued, the jaws remaining relaxed. Recovery was now 
steadily progressive. 
Case 7.—Dreadnought Seamen’s Hospital, L. L., page 
435, Sept. 24th, 1870. Idiopathic tetanus. Male : aged 37. 
Five days standing; four j5 dose of chloral were given at Ohio State Medical Society. 
175 
intervals of three hours. Four hours after last dose very 
decided and severe spasms, affecting the hands and feet, came 
on, eliciting loud cries. Pupils were then contracted ; chloral 
discontinued for a time, and brought partly under influence 
of chloroform whenever there was a return of the spasms. 
During the afternoon of same day chloral was repeated and 
chloroform frequently given. The patient passed very little 
urine, had no stool, but took fluid food at intervals of about 
fifteen minutes, and had a very fair amount of quiet and 
genuine sleep. In the evening chloroform was again ad- 
ministered on account of an unusually severe spasm, with 
screams, but died very suddenly, 20 minutes after, in a 
severe convulsive fit. 
The progress of this case was more hopeful than usual. 
The experience gleaned in this instance tends to indicate that 
chloral is worthy of an extended trial, with inhalation ot 
chloroform, whenever the tetanic spasms threaten. 
Case 8.—Dr. Gronemaunhas, published in L. L., page 
713 Nov. 19th, 1870, the case of a man aged 44: traumatic 
tetanus. Chloral alone did not relieve the spasms, but when 
morphia was given with it, the improvement was manifest. 
The prescription was as follows:' Hydrate of chloral, 150 
grains; hydrochlorate of morphia, 3 grains ; aq. dost, and syr. 
simple, a a 5jj. One fourth of this given night and morn- 
ing. The man recovered. 
Case 9—Royal Surrey County Hospital, under Mr. Eager, 
L. L., page 742, Nov. 26th, 1870. Male, age 23: traumatic 
tetanus. Gave 5j, which was then followed by 30 grains 
every three hours. Chloral continued for three days with 
apparent benefit; succeeding three days chloral was given in 
same way, but patient continued to grow worse, and died at 
end of the sixth day. 
Case of Acute Tetanus, treated by Hydrate of 
Chloral and Physostigma.—Reported by W. W. Daw- 
son, M. D. Mr. K., a gentleman 51 years of age, a me- 176 
Hydrate of Chloral. 
chanic, of good habits and excellent health, received a wound 
in the foot by stepping upon a nail. The iron penetrated 
the foot about midway between the great toe and its neighbor, 
and a short distance behind the junction of the two. 
I saw this patient with Dr. Rogers on Saturday, the 
11th ot March, the fifteenth day after the receipt of the 
injury. The wound healed promptly, with but little if any 
suppuration. On the eleventh day he was exposed to cold 
and night air, and on the twelth day lie complained of some 
rigity and unpleasantness about his jaws. ‘On the thirteenth 
day Dr. Rogers was sent for and found trismus well marked. 
He immediately placed him upon 40 grain doses of hy- 
drate of chloral every two hours, and he was kept upon it 
alone until the evening of the fifteenth day. The chloral 
kept the patient quiet, induced sleep, but the disease steadily 
advanced. When I saw him he was in the following condi- 
tion : Skin moist and cold, temperature 84 ; pulse 120 and 
feeble; countenance anxious and marked tetanic grin;'tris- 
mus intense; muscles of the back and sides of the neck 
firmly contracted ; injured limb rigid ; respiration abdomi- 
nal. After a consultation with Drs. Rogers, Elstum, Lang- 
don and Jones, the patient was given the calabar bean tinc- 
ture, three drops every four hours hypodermically, and 
fifteen drops by the mouth at the same interval. Eighteen 
hours after his temperature came up to 90; twenty-one hours 
to 91, and at the end of twenty-four hours to 98. His skin 
lost its moisture and became normal, his pulse fell to 110. 
His countenance lost the tetanic grin and presented a calm 
and happy expression. The trismus, opisthotonous, and 
rigidity of the limb less marked. 
Thus far the bean had an unmistakable impression, but 
under its use convulsive actions were developed, accompan- 
ied by great distress and restlessness. Immediately after a 
spasm the pulse showed 130, soon fell to 110. The pain and 
restlessness were controlled to some extent by a return to Ohio State Medical Society. 
177 
the chloral, but at 9J o’clock on the night of the sixteenth 
day he died in a violent convulsion. 
In analyzing this case it is apparent that the chloral acted 
as a hypnotic, but exerted no influence whatever upon the 
progress of the tetanus. The conduct of the physostigma 
was striking, it banished the tetanic grin, brought up the 
temperature from 84 to 98, warmed up the skin, reduced the 
pulse from 120 to 110 and gave it force, and lessened the 
muscular rigidity, but was not sufficient to control the disease. 
Case of Chronic Tetanus treated by Hydrate of 
Choral.—A patient was admitted to the Cincinnati 
Hospital during the past winter, with tetanus of ten days 
standing, the result of a slight scalp wound. Opisthotonos, 
trismus, abdominal rigidity and great epigastric distress. 
In this case the chloral was used, and in controling the pain 
it was successful. The tendency in cases ten days old is 
towards recovery, and I could not see that the remedy had 
any effect whatever, except that which I have already indi- 
cated—it allayed suffering and induced sleep, whilst the te- 
tanus exhausted itself. 
CASES ON DELIRIUM TREMENS. 
Four cases, reported by E. Hadly, M. D., of Indianapolis. 
First case gave 5ss of chloral at night; following morning 
found him in a half dozing condition ; repeated dose, after 
which he slept well. Restlessness increased again at night; 
then'gave 5i of chloral, an hour later he was sleeping soundly. 
Next morning called for breakfast and ate heartily; from 
this time gradually improved. 
Second, third and fourth cases were similar and with like 
good results. 
Six cases reported by Dr. Balfour, Edinburg Medical and 
Surgical Journal, May, 1871. First one of maniacal fero- 
city, and had been under treatment for three days. Two 178 
Hydrate of Chloral. 
closes of chloral, 30 grains each, with an interval of an hour 
between them sufficed to induce refreshing sleep and restore 
patient to health. The five other cases of varying, degrees 
of severity, all with most satisfactory results. 
Three cases reported by Dr. W. J. Niehol, Nashville 
Journal, August, 1870. Chloral was given in 20 grain doses, 
at intervals of two hours. In each it was only necessary to 
repeat the dose once, sleep being induced. 
Two cases, reported by C. A. Stivers, M. D., of San Fran- 
cisco Pacific Medical and Surgical Journal, Aug. 27th, 1870. 
Both cases had to be confined in a jacket. First case took 5ii 
divided into four doses, in fourteen hours. Following day 
was discharged from treatment. Second case only required 
two 30 grain doses, with like result. 
One case by Win. S. Bowen, M. D., Asst. Surg., U. S. N. 
Male: aged 27 ; Seaman. Maniacal delirium; had been 
under treatment for three days. On admission gave 30 grains 
of chloral, an hour later 20 grains. Six and a half hours 
after lie became more excited, and the hallucinations increased; 
gave then 5j. Five minutes after he was seized with con- 
vulsions, similar to those of a person partly under the in- 
fluence of ether or chloroform, and he unconsciously passed a 
large quantity of urine, this was followed by profound sleep, 
from which he did not awake for eleven hours, when he im- 
mediately asked for his breakfast, ate a hearty meal, then 
had several hours sleep. 
Case of Failure.—London Hospital, London Lancet, 
page 804, June 4th, 1870. Male: aged 33. Took 20 grain 
doses; after taking five doses was quiet for half an hour, but no 
sleep. Chloral was continued for two days, was then placed 
on morphia, which produced sleep. 
Three cases by Charles Murchison, M. D., L. L. D., F. 
R. S., Oct. 29th, 1870; L. L., page 596. First case gave 
5ss every four hours; after second dose slept fourteen hours. 
Second case gave 5ss every four hours; after fourth dose had Ohio State Medical Society. 
179 
a prolonged sleep, on awakening from which the symptoms 
of delirium tremens had almost disappeared, but he rapidly 
sank from an extension of a recent attack of pneumonia and 
died in three days. 
Third case constant vomiting; gave bismuth and chloral, 
each 5ss every four hours; after six doses vomiting stopped. 
Chloral was continued as before, for two days, patient sleep- 
ing at intervals. 
Two cases under care of Mr. Lansdown, Bristol Gen. Hos- 
pital. First case J : aged 41; compound fracture of tibia and 
fibula. Third day after admission delirium tremens came on; 
30 drops of the liq morphia was administered hypodermically, 
but produced no effect. Then gave 5i of chloral, this made 
him drowsy for a minute and nothing more. Thirty min- 
utes after another 5i was administered, in a short time he fell 
into a sound sleep which lasted for two hours. Then gave 
5i, after which he slept for several hours. He was much 
better, no delirium ; gave 5i following night. 
Second case. Female : age 57 ; fracture of tibia; third day 
attacked with delirium tremens. Gave 30 grains ; excitement 
increased. She then took a 3i without effect; in half an 
hour dose was repeated ; this did not absolutely quiet her; 
again repeated dose in half hour. This finally quieted her, 
after which she had a deep sleep, breathing heavily, but 
presented no cause for alarm. After this sleep she was free 
from delirium, but two doses of 5i each was subsequently 
given, simply to procure rest. Of these two cases the man 
took oiii in first six hours, the woman took same quantity in 
one hour in addition to 5ss she had taken during the day. 
Case by Henry T. Chapman, M. I)., London Medical Times 
& Gazette, page 419, Oct. 2d, 1869. Male: age 60; three pre- 
vious attacks, sleep had been procured by morphia. In this 
attack it signally failed. Five hours after the last ineffectual 
dose of morphia gave 30 grains of chloral. In less than five 
minutes he was asleep, and slept heavily for nearly an hour, 180 
Hydrate of Chloral. 
the muttering and convulsive movements ceasing entirely 
after half an hour. On waking he was quite composed and 
rational, drank some brandy and water, took 20 grains more 
of chloral, and again fell into a lethargic sleep, which lasted 
seven hours, after which he steadily improved. 
Delirium tremens is one of the many maladies in which 
chloral has been used with advantage. It is a remedy for 
producing sleep, particularily in those cases where opium is 
contra-indicated. It does not interfere with elimination by 
the kidneys like opium ; the existing impurities of the blood 
favor the action of chloral by assisting in the liberation of 
chloroform. One caution with regard to it is necessary. 
Not only in this disease, but in others, the first action of 
chloral is rather exciting than sedative, and when continued 
will often produce the desired sleep. 
CASES OF CHOREA. 
Case 1.—By Dr. Britton, London Lancet, page 634, Nov. 
5th, 1870. Patient aged 9; began to show symptoms of 
chorea three months previous to presenting herself for treat- 
ment ; at this time she could neither articulate any words nor 
sit still in a chair, nor walk. If left alone she would fall 
out of her chair. She could not eat, so great was the diffi- 
culty of swallowing. After treating her for six weeks with 
iron quinine, sulphate of zinc, strychnia, bromide of potassa 
and digitalis, without improvement, gave 10 grains of chloral 
at bed-time which procured her a good night’s rest, followed 
by marked improvement during the day. This treatment 
was continued for four nights, and in two weeks was dis- 
charged well. 
Case 2.—By Dr. James Russell, Medical Times and Ga- 
zette, page 30, Jan. 8th, 1870. Chorea during pregnancy. 
M. E. M., aged 21, live months advanced in pregnancy, 
with first child. Choreic movements developed themselves Ohio State Medical Society. 
181 
from an unusually early period of gestation almost from be- 
ginning. For two or three weeks previous to treatment 
movements had become violent, so that she was unable to 
stand, and was confined to her bed. Sleep very much dis- 
turbed. Lost the power of articulating. Full doses of 
bromide of potassa failed entirely; then gave in twenty-four 
hours seven doses of chloral. First two doses 10 grains each, 
succeeding ones of 15. First two doses procured some sleep, 
but after the third sleep became more continuous, lasting 
successively for three, five, and three and a half hours. 
While awake the movements were much less. She was kept 
under the influence of chloral for ten days and in one month 
thereafter discharged, nearly well. 
MANIA. 
Case 1.—By Alex M. Adams, M. P., London Lancet, Jan. 
22d, 1870. Slender, delicate looking woman; four days 
after confinement attacked with ungovernable mania; shaved 
head and applied leeches and ice; gave 5ss bromide of po- 
tassa, and repeated it in two hours; mania continued ; twenty- 
five hours after attack gave 40 grains of chloral; in five 
minutes she was calm, in ten minutes fell asleep. The mania 
being periodical chloral was given at times in 40 to 60 grain 
doses for a fortnight with favorable result. 
Case 2—By A. H. Hunt, M. D., Medical and Surgical Re- 
porter. Female: dementia of eleven years standing, a very 
noisy case; was treated with marked success by chloral in 
10 grain doses as required. 
Case 3.—Thomas H., age 62 : periodical insanity of 30 
years standing; 10 grains of chloral always produced five 
to six hours sleep. 
Case 4.—Jane C., age 60; despondency and melan- 
choly of a suicidal nature. Four years standing; was de- 
cidedly benditted. 182 
Hydrate of Chloral. 
Case 5.—M. T., age 52, acute suicidal mania of five 
years standing, supposed to be caused by uterine trouble. 
The patient is laboring under the delusion that she is debar- 
red from the privilege of entering heaven. She was easily 
controlled by chloral. He also reports five other cases 
controlled by chloral, 10 to 20 grains producing five to six 
hours sleep. 
W. J. Elstun, M. D., in a paper read before the Indian- 
apolis Academy of Medicine, reports five cases of insanity, 
where chloral produced quietude or sleep in each for several 
hours, bu.t had no perceptible effect in allaying the mania. 
Dr. Clouston, Medical Superintendent of the Cumberland 
and Westmoreland Asylum, says that it is a certain sleep 
producer, that by the use of chloral, attacks of insanity may 
probably be warded off in some eases; that its action is es- 
pecially applicable to recent cases of insanity, or to subdue 
temporary excitement. 
He, however, states that whether it does good or not it 
never does harm, and in this respect is king of all naii- 
cotics. 
PUERPERAL CONVULSIONS. 
Case 1.—By It. D. Fox, M. D., London Lancet, July 
16th, 1870, page 101. E. S., age 15J: primipara in labour 
eight hours, and had progressed satisfactorily till a few min- 
utes before I was called, when, the head having begun to 
press well on the perineum, the girl went off into puerperal 
convulsions. Fits were frequent but not powerful, sensible 
during the intervals. Ordered at once some calomel, sina- 
pisms to neck and turpentine enema. Four hours later fits 
more severe and frequent; two hours later fits almost con- 
tinuous ; totally unconscious and very much exhausted. 
Delivered her with forceps of a dead and partly decomposed 
child. The fits then for four hours increased in severity 
and frequency, pupils dilated and hardly acted at all. She Ohio State Medical Society. 
183 
had a feeble pulse of 100. Gave 30 grains of chloral, saw 
her two hours later, had only one fit, pupils normal and 
acting. Eleven hours later she was in a fitful sleep, tossing 
about the bed a good deal, and with occasional twitching. 
Gave the second 5ss of chloral; followed by a quiet sleep of 
six hours. Then gave 10 grains every four hours, in a mixture, 
with small doses of digitalis, hyoscyamus, and bicarbonate 
of potash; continued to improve. No family or previous 
history of epilipsy. 
Gasp: 2. By A. C. Campbell, M. IX, London Lancet, 
page 153, July 30th, 1870. Mrs. J., age 28; primipara, 
full time, along with the first labor pains a very severe epi- 
leptic convulsion made its appearance, the paroxysms recur- 
ring every half hour, at the commencement of each labor 
pain, and leaving her unconscious during the intervals ; gave 
40 grains of chloral, no return of convulsions ; pains in- 
creased, both in strength and frequency. She remained 
insensible and quiet, only being aroused by the pains. 
Delivered in three hours after administering chloral, of still 
born child. One hour later left her sleeping soundly, having 
no knowledge of a child having been born. Three hours 
after delivery convulsions recurred with more or less severity 
every fifteen minutes, along with after pains. Thirty grains 
of chloral was given, and in 20 minutes she was asleep and 
slept well all night, no return of convulsions. Made a good 
recovery. 
Case 3.—Ilcported by Baron Paid von Sergdewitz, of 
Bale, (British Medical Journal,) to the Obstetrical Society 
of London, case of violent puerperal convulsions in a woman 
suffering from endocarditis, subsequent to delivery, in which 
chloral at once arrested the fits, after various other remedies 
had been used in vain. 
Case 4.—By Dr. Milne; Edinburg Medical Journal, May 
1870. The case was purely a psychial one, due to the shock 
of a sudden, loud and unexpected sound; the benefit he ob- 184 
Hydrate of Chloral. 
tained from chloral was considerable, although not sufficient 
in his estimation to send one into ecstacies, or impress one 
with the belief that a novel cure had been brought before 
us of unexampled power. 
Case 5.—Communicated to the Imperial Surgical Society, 
March 23d, 1870. Puerperal eclampsia in a primipara; 
convulsions came on during labor, and continued after de- 
livery. All the ordinary remedies having failed to afford 
relief, chloral was had recourse to, in increasing doses, com- 
mencing with 4 grammes. When the dose reached six gram- 
mes, the patient fell into a deep and quiet sleep, which con- 
tinued for twelve hours. After awakening, she had slight 
attacks, which were relieved by chloral, and complete re- 
covery ensued. 
PARTURITION. 
E. Lambert, house Surgeon, Maternity Hospital, Edin- 
burg, reports eleven cases of parturition, with the follow- 
ing results : 
Case 1.—Intolerance of medicine. 
Case 2.—A very quiet woman, devoid of excitability. 
Result favorable. 
Case 3.—The marked effect was a bringing about rcgu- 
larily of the recurrence of pain, and the great relief that she 
said the medicine gave her. 
Case 4.—Negative result. 
Case 5.—Parallel of case 2. 
Case 6.—Refractory. 
Case 7.—Ergot and chloral administered conjointly; too 
much antagonism. 
Case 8.—Marked cerebral disturbance for a short period. 
Case 9.—Very favorable result, but marked by the occur- 
rence of sub-delirium half an hour after delivery. 
Case 10.—Perfect anaesthesia for half an hour. 
Case 11.—Painless labour throughout. Ohio State Medical Society. 
185 
His conclusions are that chloral is an agent of great value 
in the relief of pain during parturition, and as demonstra- 
ted, labour can be conducted from its commencement to its 
termination, without any consciousness on the part of the 
patient, under the sole influence of chloral. The effects be- 
ing continued beyond the completion of labour and the re- 
pose experienced by the patient after labour, is one of the 
favorable circumstances to be noted in considering its appli- 
cation to child-birth. 
Chloral not only does not suspend, but rather promotes 
uterine contractions by suspending all reflex actions 
which tend to counteract the incitability of the centers of 
organic motion. Labours under chloral will probably be 
found to be of shorter duration than when natural, for un- 
conscious contractions appear to have more potent effects than 
those which are accompanied by sensation of pain. It should 
be exhibited in fractional doses, say 15 grains every quarter 
of an hour, until the required effect is produced. 
PERTUSSIS. 
“Alex. M. Adams, M. D., in London Lancet, Feb. 5th,. 
1870, reports having treated several cases of whooping cough 
in children five to six years of age, with 5 grains two or 
three times daily. If cough is worse at night increase the 
dose.” I have found it a most valuable remedy, having trea- 
ted many eases of whooping cough with favorable results, 
varying the dose from three to seven grains and repeating 
dose as necessary to allay coughing. 
Dr. A. F errand reports in the Bulletin De Therapeutique 
several cases with unbounded success, no coughing at night, 
but sweet refreshing sleep. 
Several cases of asthma have been reported as being suc- 
cessfully treated by chloral. I)r. A. J. Miles, of this city, 
ASTHMA. 186 
Hydrate of Chloral. 
presented me with reports of a number of cases of asthma 
which he treated with chloral in 5ss doses, the second dose 
generally producing the required result. 
Amputation during Anaesthesia, Produced by 
Chloral.—Dr. Noir published in London Lancet, Jan. 1st, 
1870, a case of a man aged G4 suffering from osteo sarcoma of 
the leg. The patient was anxious to have limb amputated. 
Eight, A. M., took 60 grains of hydrate of chloral; up to 9 
o'clock he frequently tried to vomit, with violent excitement, 
until 10 A. m.; he then fell asleep, and was insensible to so 
great an extent that he could be moved freely without wak- 
ing. Sleep lasted one and a half hours; he awoke and 
wanted something to eat. Two days after took 75 grains at 
8 A. M.; was uncomfortable for an hour, when he fell into a 
deep sleep, and underwent amputation of leg without moving 
or uttering a sound; the coma was so alarming and prostra- 
tion so complete that Dr. Noir remarked that it would be 
imprudent to use chloral as an anaesthetic in operations if it 
continues to be followed by these dangerous symptoms. 
There can be no doubt but that the anaesthesia was com- 
plete. 
Discoveries like this have long histories, and the efforts are 
often misdirected, the experiments insufficiently recorded, 
and the conclusions erroneously drawn from the crumbling 
dust of errors and imperfectious. 
If we were to refer to various formed essays upon thera- 
peutics that have appeared of late years, we would find that 
a certain timidity, has in many instances, induced authors to 
cling to phrases which represent physiological theories note 
virtually dead—and the use of these phrases has injuriously 
affected the value of our systematic teaching, on the subject 
and action of medicine, leading energetic and practical men 
to regard it as somewhat pedant and unreal, and hence the 
many misdirected uses, and entire failures which otherwise 
might have properly contributed praise according to deserts. Ohio State Medical Society. 
187 
It is the general custom of writers on therapeutics to 
assume that the same qualities which distinguish the action 
of any drug when administered in large doses, must distin- 
guish it when administered in a smaller quantity and vice 
versa, the only difference being of degree and not of kind. 
Thus : opium in a medicinal dose produces sleep, in a 
poisonous dose coma, the latter cause being argued as the 
extreme development of the other. 
If the dogma that the action of a drug is essentially the 
same though not in degree, be true in any sense, as would 
warrant its being assumed as a basis of therapeutical inquiry 
it ought to be true universally—but not so. 
Thus: common salt in small quantities is a perfectly 
indispensible article of human food, in a medium dose a safe 
and useful emetic medicine, while in extremely large doses it 
is an irritant poison and has caused death. (Med. Gazette 
vol. I., p. 559—1840.) 
The same might be said of iron, which is one •of our most 
valuable tonics, given in small doses, but in large quantities 
it is a most violent irritant, and will poison. So with strych- 
nia and arsenic in their therapeutical dose we have a powerful 
tonic, and are often the resort in extreme cases, but in large 
quantities they tell in action louder than words. The same 
might be said of chloral, whose therapeutical action consists 
in a regular progressive extinction of the vital properties of 
the various portions of the nervous system. 
Producing first, with a small dose calmness and tranquility 
as shown in I)r. Patton’s case, (case 6th in our report on 
neuralgia.) 
2d. Producing deep sleep, insensibility, as shown by Dr. 
Richardson in his experiments upon the pigeon, and as shown 
by Dr. J. C. O. Wills’ case (case 4th neuralgia) when deep 
sleep was produced for 7 hours. 
3d. Deep sleep with complete anaesthesia, as in the 188 
Hydrate of Chloral. 
pigeon when grains were given. As illustrated by Dr. 
Chapman’s case of delerium tremens. 
4th. Complete insensibility as when 5 grains were given 
to the pigeon, and as recorded in Dr. Noir’s case $f, amputa- 
tion when 75 grains were taken at one dose. 
6th. Death as when seven grains were given to the pigeon 
but not as on man.* 
My experience with chloral has shown that a small dose 
first produces a slight invigoration, with face bright and 
intelligent, only to a degree proportionate as shown in perfect 
health, or owing to the rajtio it exerts itself upon the physical 
characters of the corpuscles before it diminishes the power 
of the organic constituents of the blood to unite with oxygen. 
2nd. With the dose increased pro re nata we have the 
coordinate voluntary movements affected, then impairment 
of consciousness with a sweet sleep following. Fall of 
temperature and respiration; giving the full effects of a 
hypnotic, with all the pleasing results that could be wished 
for, or in other words producing natural sleep. The same 
results having been corroborated by Dr. Ferran in his cases 
of pertussis. 
3d. I find that by increasing the dose proportionally to 
the person, we next produce a deep sleep with insensibility, 
that will last for hours even with noise and jostling around 
but no dreams, the sleep seemingly being too deep, and having 
on waking a tendency to depression. The depression that I 
have witnessed after giving large doses of chloral, seemed 
to have prostrated Dr. Noir’s man after amputation so much 
that he became alarmed and remarked that it would be 
imprudent to use chloral as an anaesthetic in operations if it 
continued to be followed by these dangerous symptoms. Its 
effects upon a healthy system has no comparison with other 
hypnotics or anaesthetics. 
The ancient Egyptians used many drugs for producing a 
state of intoxication or ecstacy ; consisting of Indian hemp 
* Since writing the above one death has been recorded. Ohio State Medical Society. 
189 
and the juice of the poppy, and when opium was scarce they 
used the “electuarium bernavi.” The effects of these prep- 
arations of Indian hemp were, first exhilarating, then the 
men became talkative and would sing love songs and laugh ; 
then they were rendered delirious and would fight and 
mutilate each other ; then after an hour or so came a stage of 
wild excitement, with violent anger ; lastly a stage of grief 
during which they lament and weep, then they return to 
normal health. Prosper Alpinus gives the formula, white 
poppies, seeds of henbane, opium, stem and flowers of eu- 
phorbia and saffron. The effects may be imagined from the 
nature of the ingredients. 
The ancient Scythians used to breathe the fumes of burning 
hemp, just as the Hindoos do now; just as the Chinese smoke 
opium. The custom of inhalations, too, was very widely 
spread among the barbarians along the shores of the Caspian, 
who lit fires of fruits and seeds, and sat around them breath- 
ing the fumes, till they became intoxicated ; or as the Indians 
who throw tobacco on their fires during religious ceremonies, 
to transport them into ecstacy ; or as the priestesses at Delphi 
who became half intoxicated by the fumes of narcotic plants, 
before delivering the oracles. In the 12th century the 
famous confection of Hugo di Lucca * was used to produce 
sleep. And these usages no doubt had a tendency to lead 
to the search and discovery of anaesthetics. 
Opium eaters who are so abundant over our land, say that 
they eat it for the happy effects and pleasing sensations that 
it produces upon the healthy economy, and some become so 
accustomed to it that they can tolerate enormous quantities. 
Chloroform produces dimness of vision, then exhilaration 
with disposition to talk, laugh and sing, dreams and fancies 
occur, events of past life may be recalled, conversations may 
be repeated and actions produced. Sailors sometimes go 
* Composed of opium, henbane, mandragora and hemlock mingled with 
various juices. 190 
Hydrate of Chloral. 
through their nautical maneuvers, young ladies will sing 
“Beautiful Star,” some will pray, some swear, and others 
will relate their love mishaps. But not so with chloral, it 
has no tendency to produce any such state of ecstacy as Indian 
hemp, or the pleasing effects of opium, neither has it any of 
tfie exhilarating tendencies of chloroform when inhaled, 
though the active principle is chloroform liberated in the 
blood. Hence Ave have the full assurance that it can not be 
used by the common people to abuse themselves with—produc- 
ing their supposed happiness. This property of the drug is 
one of the best recommendations to its adoption into common 
use. 
This genial idea that was implanted at an early day and 
beautifully described by Helen to Menclaus when she offered 
him the “sleeping” cup : 
‘‘To clear the cloudy front of wrinkled care, 
And dry the tearful sluices of Despair: 
Charm’d with that virtuous draught, the exalted mind 
All sense of woe delivers to the wind.” 
Though once developed into boldness and almost general 
use, and is even now destroying the happiness of thousands 
of families and homes, should be superseded—old systems 
should be discarded and new ones adopted for reformation if 
nothing more. And chloral I am proud to say will not 
admit of being used, so that our fellows can be called “chloral 
eaters.” True the use of chloral will produce sleep and 
destroy physical pain, but the exhilarating effects, such as 
opium produces, are absent in chloral. It will cause no 
change in the senses as its action prevents oxygenation, it 
diminishes the arterial supply, causes a sluggishness of flow 
in the capillaries; then extending to the nerve filaments 
distributed to the lungs, producing shallowness of res- 
piration. From its effects, due to the influence of an altered 
blood, suspended oxygenation, we can not foresee any abuse 
that it may be liable to by the common people. Ohio State Medical Societij. 
191 
Dy our own trials and the summary of all the cases that 
have presented themselves, we find that hydrate of chloral 
affects the human system as per the statements of I)r. Oscar 
Liebreich, who described it as first effecting the ganglionic 
cells of the brain, and the coordinate voluntary movements 
and impairing consciousness, holding in cheek only partly 
voluntary motion. The effect is then, if carried far enough, 
communicated to the medulla, whereby stertorous and labori- 
ous breathing is effected, and lastly the ganglionic cells of 
the heart, but this last has been verified only on the lower 
animals. Considering its daily and almost universal use 
there is no agent which seems to us to require more caution 
and more skill to obtain the good and avoid the evil which 
its use entails. 
The dose of chloral must be regulated by the physician. 
My experience is that it should be used in fractional doses 
and repeated until the desired effect is produced, grsxx being 
nearly the standard dose.