A Clinical Study of Paraldehyde and 
Sulphonal. 
BY 
C. M. HAY, M.D., 
Assistant Physician to the State Asylum for the Insane, Morris Plains, N.J. 
FROM 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
July, 1889. Extracted from the 
American Journal of the Medical Sciences for July, 1889. 
A CLINICAL STUDY OF PARALDEHYDE AND 
SULPHONAL. 
By C. M. Hay, M.D., 
ASSISTANT PHYSICIAN TO THE STATE ASYLUM FOR THE INSANE, MORRIS PLAINS, N. J. 
As the value of the new hypnotic sulphonal is still being tested, an 
account of a clinical comparison between it and paraldehyde may per- 
haps add something to our knowledge. 
The very favorable experience of Cramer and others with the drug, 
together with the statement of Rabbas, “ that it is more desirable than 
amyl hydrate or paraldehyde,” led me to use it and the latter drug 
quite extensively in the insomnia of mental disease, with the view of deter- 
mining more accurately their relative worth and the kind of cases to which 
they were especially adapted, and in which they could be used with the 
best hope of success and with most benefit. 
The observations which are the subject of this paper extended over a 
period of six months, beginning Nov. 1, 1888. During this time paral- 
dehyde was used in 100 cases, and sulphonal in 166 similar cases. Each 
drug was used in 20 cases of acute and chronic disease in which the in- 
somnia was due to other than purely mental causes. The patients to 
whom either drug was administered were watched by competent nurses, 
and the exact time of sleep noted, and all these results carefully recorded. 
The standard of success was the same with each drug, and was as follows: 
From six to nine hours was counted a successful trial, from three to five 
hours a partially successful result, and under three hours a negative 
effect. The dose used varied with the age, sex, and condition of the 
patient and with the intensity of the insomnia; in the case of paraldehyde, 
from one to two and a half fluiddrachms, and sulphonal from gr. xv to 
one drachm. The after-effects were also recorded as they occurred. 
First let us study the result of paraldehyde in 100 cases, 48 males and 
52 females, embracing nearly all the varieties of disease of the mind, as 
follows: acute and chronic melancholia, acute and chronic mania, the 
various dementias, periodic mania and circular insanity, general paraly- 
sis of the insane, alcoholic mania and primary dementia. 
In 25 cases of chronic dementia (including all its varieties excepting 
epileptic), 1021 trials were made, an equal number in each case. These 
cases of insomnia varied from simple wakefulness to the noisy unrest of 2 
HAY, PARALDEHYDE AND SULPHONAL. 
the terminal dement. Of these trials 834, or 81.7 per cent., were suc- 
cessful, 12.7 were partially so, and 5.6 per cent, were negative. 
In 11 cases of chronic melancholia habitually sleepless, 397 trials 
were made, with success in 67.2 per cent., partial success in 23.4 per 
cent., and failure in 9.3 per cent. 
In acute melancholia, in the first month of the disease, 139 trials were 
made in 6 cases, of which 81.2 per cent, were successful, 7.1 fairly so, 
and 11.5 per cent, negative, while all of the cases were markedly bene- 
fited by its use. 
In epileptic dementia 66.9 per cent, of 372 trials in 7 cases was suc- 
cessful, 25 per cent, partially so, while but 8.1 per cent, were negative. 
Out of 1080 trials in 27 cases of chronic mania all markedly sleepless, 
and many accustomed to other hypnotics, 57 per cent, were successful, 
25.6 per cent, fairly so, while 17.3 per cent, were negative. 
In acute mania 66 per cent, of 198 trials in 10 cases, 4 males and 6 
females, were successful, fairly so in 14.5 per cent., and entirely negative 
in 25.5 per cent, of the trials made. Two of these cases were not influ- 
enced at all by the drug. 
In the wakeful and restless states of the second and third stages of 
general paralysis of the insane 62.6 per cent, of 193 trials upon 7 cases, 
all males, were successful, 26 per cent, partially so, while 11.4 per cent, 
were negative. 
In 5 cases of periodic mania (one was a case of circular insanity), all 
in the stage of excitement, 109 trials were made, with success in 59.6 
per cent., partial in 27.5 per cent., and negative effect in 12.8 per cent., 
while 23 trials in a case of primary dementia with gi’eat restlessness re- 
sulted in success in 86.9 per cent., while only 4.3 per cent, were negative, 
and the remainder doubtful results. 
From this we learn that paraldehyde was of most service in the in- 
somnia of the dementias, of least service in acute mania, and that its 
efficiency is nearly equal in acute and chronic melancholia and epileptic 
■dementia; also that it was less serviceable in the insomnia of the 
maniacal states than in melancholic conditions,—for only 57 per cent, of 
trials in chronic mania were successful. Strange to say, in periodic 
mania it failed in only 12.8 per cent., while in acute mania the percen- 
tage of failures was 25.5 per cent. 
Summarizing these statistics of its use, we find that of the 3515 trials 
made upon these 100 cases, 2407, or 68.5 per cent., produced from six to 
nine hours’ sleep; 711, or 20.2 per cent., from three to five hours; and 
397, or 11.3 per cent., failed utterly to produce sleep. 
Besides the foregoing cases, paraldehyde was used in 20 cases in which 
the insomnia was not due to a mental condition, but was a symptom of 
some acute or chronic disease. These cases were made up as follows: 
phthisis, 2: erysipelas, 6 ; acute rheumatism, 3 ; pneumonia, 3 ; cerebral HAY, PARALDEHYDE AND SULPHONAL. 
3 
gumma, 1; typhoid fever, 1; painful leg ulcer, 2 ; cellulitis of arm, 1. 
To these paraldehyde was given 267 times, with success in 50.9 per cent.; 
partial success in 19 per cent.; and complete failure in 30.1 percent, 
of trials. 
Following the example of H. B. Williams, M.D. (Assistant Physician, 
Arkansas Insane Asylum), I have also employed it in epilepsy and in 
the status epilepticus, but with no encouraging result. 
Leaving paraldehyde for the present, Ave will consider its newer rival, 
sulphonal. The clinical data of this new chemical are already getting 
numerous. I will refer to the following: Cramer had 92.6 per cent, ot 
“ positive success ” in 92 insane cases, with “ no instance of any unpleasant 
after-effect.” Schwalbe had, in 66 per cent, of 50 cases, a “ prompt and 
satisfactory effectwhile, in 24 cases of purely nervous insomnia, 90.3 
per cent, of his trials were effective. Rabbas employed it 200 times with 
“ good effect.” Papers have also been contributed by Kast, Ziemssen, 
Oestreicher, Schmey, Frankel, Rosenbach, Rosin, Salgo, Mathes, and 
others. Schmey asserts that it is dangerous in arterio-sclerosis, and 
Mathes and Ziemssen admit unpleasant after-effects in 19 per cent, and 
20 per cent, respectively; yet the great Aveight of their united testimony 
is in fa\ror of sulphonal; Avhile Kast says that it does not affect pulse or 
respiration, and that only very large doses loAver the blood-pressure 
(.Amer. Journal Med. Sciences, July, 1888). 
In this country papers have been Avritten by W. H. Flint, M.D. (New 
York Med. Journ., December 15, 1888), H. M. Wetherill, M.D. {Med. 
and Surg. Rep., October 13,1888), Sachs {Med. Record, October 6,1888), 
Wilson and Hutchinson {Med. and Surg. Rep., June 9,1888), and others. 
Dr. W. H. Flint had success in 82 per cent, of his trials in 33 cases. He 
recommends it especially in the insomnia of debility, and in recovery 
from the morphine habit; says it is useless in cardiac dyspnoea, and that 
it has no anodyne properties. 
My own observations of the action of sulphonal were carried out under 
the same conditions, and in about 50 of the same patients as in the case 
of paraldehyde. The number of patients to Avhom the drug Avas given 
Avas 166. Of these 69 were males and 97 females. The dose was admin- 
istered at 7 o’clock p. M., in some hot menstrum (milk, beef-tea, etc.), as 
advised by Kast. The results obtained were as follows: 
In 27 cases of epileptic dementia Avith marked insomnia, 143 trials 
were made, the dose being gr. xxx in all the trials. Of these, 123, or 86 
per cent., produced from six to nine hours’ sleep; 9.1 per cent, from three 
to five hours; and 4.9 per cent. Avere negative. 
In the more restless and noisy states of chronic mania 269 trials upon 
21 cases gave 206, or 76.5 per cent, of successes; 13.8 per cent, partially 
so ; and 9.6 per cent. Avere negative. Dose from gr. xxx to gr. xlv. 
In acute mania larger doses were necessary—average dose gr. xl; 108 4 
HAY, PARALDEHYDE AND SULPHONAL. 
trials upon 4 male and 6 female patients gave 75 per cent, successful ; 
10.1 per cent, of doubtful efficiency ; and 14.9 per cent, negative. 
In the maniacal phases of periodic mania and circular insanity 70 per 
cent, of 47 trials upon 5 cases were successful: 11 per cent, were nega- 
tive ; and 19 per cent, of doubtful value. The same doses were used as 
in acute mania. 
In 43 cases of chronic dementia (including all varieties except epi- 
leptic) 199 trials gave 70.3 per cent, successful; 18.2 per cent, fairly so ; 
and 11.5 per cent, negative. Average dose gr. xxv. 
In 33 cases of chronic melancholia without very marked mental 
depression, all sleeping habitually from one to four hours, 330 trials 
wrere made, an equal number upon each patient. Of these, 67 per cent, 
were successful; 17.2 per cent, of doubtful value; and 15.8 per cent, 
were negative. Seven of these cases could not be influenced by the drug, 
although as high as gr. 50 were given. 
In acute melancholia sulphonal was used in 21 cases—8 male and 13 
female patients, all of whom were in the first three months of the disease, 
and the majority of them were instances of extreme mental depression, 
amounting in many to absolute agony. In these cases 178 trials of the 
drug were made, Avith the result that only 49 per cent, were successful, 
while 36 per cent, were wholly negative, and 15 per cent, were doubtful 
results. 
In 6 cases of general paralysis of the insane, presenting the same stages 
as those in which paraldehyde was employed, 39 trials were made. Dose, 
gr. xxx. Of these, 30.8 per .cent, only were successful, 46.2 per cent, 
partially so, and 23 per cent, failed. 
Summarizing these results, as in the case of paraldehyde, we find that 
the whole number of trials of sulphonal upon these 166 patients amounted 
to 1313 : of these, 910, or 69.3 per cent., produced from six to nine hours’ 
sleep ; 206, or 15.6 per cent., from three to five hours’ sleep ; and 197, or 
15.1 per cent., were negative in effect. 
From the above it would appear that sulphonal is most successful in 
the insomnia of epileptic dementia, and least so in acute melancholia; 
that it is about equally efficient in the insomnia of all the remaining 
dementias and periodic mania (in the latter states its success exceeds 
that of paraldehyde by 21 per cent.) ; also, that it is far more useful in 
maniacal conditions than in depressed states, and upon this I wish to 
lay especial emphasis, as I consider that sulphonal does harm instead of 
good in any form of melancholia. The reason of its failure to produce 
sleep in such conditions may be partly due to its slowness of action, but 
the mental condition of the patient must be considered as the first factor. 
It is the after-effects of the drug, however, that make it very undesirable 
in such cases, and tend to deepen the mental depression of the patient. 
The power of sulphonal as a hypnotic in acute and chronic diseases HAY, PARALDEHYDE AND SULPHONAL. 
5 
in which pain, cough, dyspnoea, or fever were the underlying causes of 
the wakefulness, was tested in 20 cases, other than those already referred 
to. They consisted of 6 cases of erysipelas, 4 of acute rheumatism, 2 of 
phthisis, 2 of acute abscess, 2 of suppurative tonsillitis, 1 each of lead 
colic and cardiac dyspnoea, and 1 each of neuritis of upper extremity 
and asthma. In these, 190 trials were made, 42 per cent, being success- 
ful, 48 per cent, being negative, and 10 per cent, giving uncertain results. 
In the 2 cases of opium habit in which I have employed the drug, one 
case was very much relieved by it, and the patient expressed himself as 
much pleased with its effects, while in the other case it was useless, 
although large doses were given. From 120 observations upon 40 
patients, the average time in which they slept after taking sulphonal 
was found to be sixty-three minutes. 
Having considered the actual proportion of the successes and failures 
of these two drugs, I will now compare their after-effects. 
Although, as w7e have seen, these two drugs differ considerably in their 
action in the various mental diseases, as well as in other diseases, their 
greatest differences lie in their after-effects. Here they widely diverge, 
one being capable of producing very few and comparatively innocuous 
after-effects, while those produced by its fellow are, to say the least, 
capable of being dangerous to life. A paraldehyde habit has been 
noted in a few cases since the advent of the drug, but I have not yet 
seen a case, although many of the patients in this institution have been 
taking it for many months continuously. Among this class of patients 
I have in vain sought for a case; and from the very limited number of 
cases that have been reported, when we consider its very general use 
since 1882, I conclude that it must be a rare occurrence compared to 
the frequency of the chloral, chloroform, or morphine habit. It cer- 
tainly possesses two great safeguards in its taste and the odor it leaves 
upon the breath for from eight to sixteen hours after its ingestion. 
Whether sulphonal is liable to form a habit I am at present not able to 
say; but I have one patient who has been taking it about six weeks, 
and who has recently repeatedly asked to have the dose increased. 
Neither have I seen the continuous use of paraldehyde followed by 
serious nasal ulceration, as Hr. J. G. Kiernan has reported (Wood's 
Therapeutics), although in several cases I have seen a scattered papular 
eruption over the upper part of the body in debilitated subjects. 
The principal after-effects of paraldehyde in my cases have been due 
to its irritant action upon the gastro-intestinal mucous membrane, and 
for this reason it should be given well diluted. Diarrhoea, vomiting, 
and impairment of the digestive functions have occurred in about 7 per 
cent, of cases. Strange as it may appear, I have seen its continuous use 
followed by increase in appetite and a corresponding increase in diges- 
tive power in several cases of atonic dyspepsia. Whether this was 6 
HAY, PARALDEHYDE AND SULPHONAL. 
wholly due to its stimulant action upon the gastric mucous membrane, 
or was the result of the relief of sleeplessness, it is difficult to say, but I 
think that probably both combined gave the result. I have never seen 
paraldehyde produce any serious alteration in the pulse, temperature, or 
respiration, and these observations are abundantly confirmed by many 
Avho have extensively used the drug. It will be sufficient to quote from 
a paper by H. C. Harris, M. D., on its use upon 152 patients at the Nor- 
ristown, Pa., Insane Asylum. He says : “ Its advantage over chloral, 
in our experience, is mainly that there is no danger from its action on 
the heart; in fact, 100 minims have been given to cases of acute mania 
without the slightest noticeable effect upon the heart or respiration.” 
The very fact that this drug has been so extensively used since 1882, 
and that so few bad effects have been noted, proves pretty conclusively 
its safety, even in the fullest therapeutic dose. 
What evidence have we that sulphonal is capable of producing more 
serious symptoms ? The very high commendation which it received at 
first led to an extensive use of the drug, and very soon cases were re- 
ported in which unpleasant symptoms occurred. Dr. Bornemann 
(Deutsche medizinal Zeitung, Nov. 26, 1888) relates a case—male, aged 
fifty-three, suffering from the morphine habit—who was given 90 grains 
in four hours. Muscular weakness and incoordination and great mental 
depression were produced, while the ataxia did not disappear until the 
sixth day. Dr. Schotte, of Cassel, has reported a case in which difficult 
movement of the tongue, stupor, headache, and loss of appetite persisted 
for four days, and were succeeded by an eruption, like that of measles, 
over the entire body, lasting two days. Dr. Engelman (Wiener medi- 
zinische Blatter, Nov. 1, 1888) gives a case—female, aged forty, suffering 
from chronic metritis—in whom only gr. xxx produced, the following 
morning, a diffuse scarlet eruption, extending symmetrically over the 
body, which subsided with violent itching on the third day. 
It may be stated that 30, or 18 per cent., of my 166 cases experienced 
unpleasant after-effects. Some persons seem very susceptible to it (as 
in Case III. detailed below), while I have given in violent maniacal 
states as much as one drachm daily for twelve days, with no alarming 
symptoms. The after-effects of sulphonal are far more variable and are 
more significant of its more powerful action upon the great nerve centres 
than those of paraldehyde. The effects which it in some cases produces 
bear no direct proportion to the amount ingested, so that the production 
of the various symptoms in these cases must, at least in great part, 
depend upon other conditions of the organism itself; while I have no 
doubt that the conditions of its solution in and absorption from the 
intestinal tract have great influence also in their production. The after- 
effects which I have seen follow its use will be best understood from the 
following detailed cases: HAY, paraldehyde and sulphonal. 
7 
Case I.—Female; aged forty; periodic mania. In the intermissions 
patient was in good health. During an attack of active mania one 
drachm daily in divided doses was given for two days. On the morning 
of the third day she was much depressed mentally, pulse small and 
feeble, respiration distinctly slow, and temperature 96.4° F. Upon 
attempting to walk, great muscular weakness wras evident. This condi- 
tion lasted for two days, after which her mania re-appeared. Sulphonal 
was resumed in the same dose, and the same symptoms returned on the 
fourth day, with very marked muscular incoordination added. These 
symptoms abated gradually in three days after the withdrawal of the 
drug. 
Case II.—Male; aged twenty-six; acute mania. Was given gr. xv 
three times a day. Beginning on the second day, this patient had suc- 
cessively headache, vertigo, slight and, later, decided weakness of the 
heart-beat, pallor of the surface, coated tongue, dryness of the mouth 
and pharynx, and repeated emesis, all passing away when the drug was 
stopped. 
Case III.—Female ; aged thirty; epilepsy. After one dose of gr. xxx 
of sulphonal slept well, but, when seen sitting in a chair the following 
morning, could not be roused. The pupil was half dilated, and reacted 
to light very slowly ; the eyelids drooped, and the head inclined forward 
upon the chest; sensation to the prick of a pin was abolished; the 
muscle reflexes could not be obtained, and respiration was slow and 
somewhat irregular. These symptoms persisted for forty-eight hours, 
and then gradually passed away. There was in this case total disability 
to walk, even with the assistance of two persons. 
Case IV.—Male ; aged thirty-three. The continued use of gr. xxx 
of sulphonal at night followed by lassitude, distaste for food, weakness, 
occasional vomiting, and diarrhoea. 
Case V.—Male; aged forty-five; chronic melancholia. Gr. xlv of 
sulphonal daily for three days produced extreme weakness, dryness of 
the mucous membranes, and a peculiar semi-delirious condition, in which 
the patient seemed conscious at times that he was acting strangely. 
Case VI.—Female; aged sixty-five; chronic melancholia of a mild 
form. This patient is sensible in conversation and only looks upon the 
dark side of life; insomnia very marked. Sulphonal, gr. xxx, at night 
for ten days was given, when symptoms resembling closely those of acute 
alcoholism came on. She conversed volubly, incoherently, and without 
her accustomed sense, while a decided stagger in her gait was manifest. 
This latter symptom seemed due partly to lack of coordination, wThile 
muscular power seemed also affected. 
Case VII.—Female; aged thirty-two ; periodic mania. In the inter- 
missions is afflicted with persistent insomnia. Sulphonal, gr. xxx, at 
night was given with good effect, but on the fifteenth day an eruption 
appeared. This consisted of deep red blotches, slightly elevated, well 
defined, varying in size from a pin’s head to a split pea, and uniformly 
distributed over the body. Intense itching accompanied it. This erup- 
tion faded in three days, the drug being stopped, but when sulphonal 
was resumed, a week later it came back and presented the same ap- 
pearances. 
Case VIII.—Female; aged thirty-eight; acute melancholia, asso- 
ciated with phthisis and exophthalmic goitre and intense insomnia, 
Was given sulphonal, gr. xxx, at night, and after the third dose left 8 
HAY, PARALDEHYDE AND SULPHONAL. 
foot became swollen and red, with considerable oedema of subcutaneous 
tissues. In a few hours similar patches of erythema, with less oedema, 
appeared on both thighs, arms, and anterior surface of the trunk. In 
the latter situation it assumed a papular form upon an erythematous 
base. These patches were the size of the hand, and rapidly appeared 
and disappeared in the various regions named. This condition passed 
away gradually in four days after the drug was stopped. During this 
time the woman had a slight degree of fever, lassitude, and loss of 
appetite. 
Case IX.—Male; aged fifty ; chronic mania. After having had gr. 
xxxv of sulphonal for a week at night, began to show lassitude, con- 
gested eyes, dry tongue, weak pulse, diarrhoea, anorexia, and muscular 
weakness and incoordination. When the latter symptoms appeared sul- 
phonal was discontinued, and they gradually passed away in three days. 
Case X.—Female ; aged twenty-eight; epilepsy. After gr. xxx of 
sulphonal one day, followed by gr. xxx the next day, appeared dull and 
weak, and twelve hours later had great difficulty in swallowing even 
liquids. These symptoms passed away in twenty-four hours. 
The last case that I will refer to is of especial interest as illustrating 
the severity the after-effects of this drug may attain. 
Case XI.—This patient was a vigorous, healthy female, of fine physique, 
but subject to epileptic seizures. Her attacks have been rapidly increas- 
ing in frequency, and gr. xx of sulphonal three times daily were added 
to her treatment. After taking six doses, dizziness and drowsiness ap- 
peared, which, by the following day, had deepened into stupor, with 
unsteadiness of gait and an indescribably dull appearance of her usually 
attractive face. The patient was in a dreamy state with drooping eye- 
lids, an anxious expression, and seemed in constant fear of some im- 
pending danger. She frequently exclaimed, “ I hardly know where I 
am.” At this time there was also dryness of the buccal mucous mem- 
brane, decided dimness of vision, and rapidity and weakness of the pulse. 
Sulphonal was now stopped, but, nine hours later, she fell upon the floor 
from weakness, and one hour later her condition was as follows: She 
was unconscious but could be roused with difficulty, respiration shallow, 
laborious, and 40 to the minute; mouth very dry, but she swallowed 
without difficulty. The tendon reflexes were nearly absent, while the 
pupils, which were equal and somewhat dilated, reacted to light very 
slowly indeed. Sensation in the skin and conjunctive was abolished. 
The bodily temperature was 97° F. After six hours patient uttered a 
few inarticulate words and relapsed into profound unconsciousness, which 
lasted for fifteen hours more, when she again became partially conscious, 
and for the next twenty-four hours she kept alternating between coma 
and consciousness. During the comatose periods the respirations were 
more rapid, and at one time were 42 to the minute, while the pulse was 
weaker than when she became partially conscious. On the third day 
she could be roused by the voice, but recognized no one. Xow her 
respiration was 25 to the minute and the heart was acting much better. 
In the afternoon of the fourth day pulse and respiration were about nor- 
mal. There was extreme mental confusion and a mild delirium at 
times. By the seventh day the woman was nearly in her usual good 
health again. At no time was there any fever. HAY, PARALDEHYDE AND SULPHONAL. 
9 
These cases certainly proved that suphonal is capable of being a dan- 
gerous remedy, even when used in therapeutic doses. Many of our 
patients, however, received larger doses and yet suffered no bad effects. 
In one case of chronic mania gr. lxxv daily were given for over a week 
without bad effect, and it did not produce sleep. The remainder of the 
cases in whom marked after-effects were noted suffered in milder degrees 
sulphonal intoxication, as detailed in the above eleven cases. The most 
common of the effects observed were lassitude, dizziness, and vertigo, 
diarrhoea, vomiting, and great mental depression, with a dreamy half- 
unconscious expression upon the face. In two cases partial loss of mus- 
cular coordinating power was the only effect produced, and these patients 
did not sleep from its use. The very various symptoms produced by 
sulphonal suggest a very general action upon the nervous system, but it 
remains for the experimental therapeutist to explain their causation. 
Cervello says: “ Paraldehyde affects the cerebrum, spinal cord, and the 
bulbus successively, abolishing the reflexes, causing anaesthesia by an- 
aemiating the brain and cord. It is eliminated by the lungs, and is not a 
cardiac poison.” In some of my cases in which sulphonal was employed 
weakness of the circulation was very marked, while in Case X. respira- 
tion appeared chiefly affected. Why the drug in one instance produces 
delirium, in a second incoordination of the muscular system, in a third 
difficult movement of the tongue, and in a fourth stupor, cannot be ex- 
plained from our present knowledge of its action. 
The practical deductions that my experience with these two drugs 
would suggest are: 
I. That paraldehyde is the safer hypnotic where a continuous action is 
desired. 
II. That paraldehyde has a wider range of application in mental dis- 
ease than sulphonal, and that in the insomnia of acute or chronic disease, 
where pain, cough, dyspnoea, or fever exist, sulphonal is less effectual 
than paraldehyde. 
III. That in all depressed mental states sulphonal acts ineffectively, 
and acute melancholia should be a contra-indication to its use, while in 
maniacal conditions it is more satisfactory than paraldehyde. That the 
use of the former in general paralysis of the insane should be carefully 
considered, while in acute melancholia the latter is usually effective. 
IV. That a high degree of physical debility with insomnia should 
contra-indicate sulphonal. 
V. That in 18 per cent, of cases various degrees of sulphonal intoxi- 
cation appear, and that it would seem that the drug is capable of being 
dangerous to life, and that, therefore, the commencing doses should be 
small, some persons being extremely sensitive to its influence.. 
VI. That the effects produced by sulphonal are not always in propor- 
tion to the dose administered, and that in some cases at least it very 10 
HAY, PARALDEHYDE AND SULPHONAL. 
seriously interferes with the normal bodily secretions, while paraldehyde 
does so to a very much less extent. 
In conclusion, my thanks are due to Dr. Eliot Gorton and Dr. L. L. 
Mial for aid in collecting the results referred to, and for references to 
cases in their wards. THE AMERICAN JOURNAL 
OF THE MEDICAL SCIENCES 
Is the oldest and best-knoivn medical periodical of America,having 
been founded in 1820. It numbers among its contributors the most 
eminent names in the profession, and, according to unquestionable 
authority, “It contains many original papers of the highest value ; 
nearly all the real criticisms and reviews which we possess; and 
such carefully prepared summaries of the progress of medical 
science and notices of foreign works, that from this file alone, were 
all other publications of the press for the last fifty years destroyed, 
it would be possible to •reproduce the great majority of the real 
contributions of the world to medical science during that period." 
Published monthly. $4.00 per annum. 
THE MEDICAL NEWS 
Is the leading medical newspaper of this country. Started in 1843 
as a Monthly, it was changed to a Weekly in 1882. It has been 
shaped to furnish the profession at rapid intervals with the latest 
information on all medical subjects. During the year 1888 THE 
AMERICAN JOURNAL and THE MEDICAL NEWS published 2160 
articles on Progress alone„ and, in addition, one and three-quarter 
million words of original matter, the equivalent of 9 octavo 
volumes. THE NEWS is sent post-paid for $j.00 per annum; 
THE AMERICAN JOURNAL for $4.00, or both at $7-go. 
THE YEAR-BOOK OF TREATMENT FOR 1889 
How in press for its fifth annual issue, gives a classified statement 
of the value and uses of all remedies which have been introduced 
and practically tested during the year. Price, $1.25; or in com- 
bination with either or both the above journals, 75c. 
THE MEDICAL NEWS VISITING L/ST 
Contains 48 pages of indispensable data and 176 blank pages, 
ruled to accommodate all records of practice. Handsomely bound 
in red seal, $i.2p. In combination with either or both above 
periodicals, 73c. Or, JOURNAL, NEWS, YEAR-BOOK and VISITING 
LIST, $830. 
Lea BJothafg & Co., Dublighei1^, 
V 1 706 & 708 
PHILADELPHIA. —Sansom Street.—