The habitual use of chloral constitutes a disorder, which, if not as persistent as the opium-habit, has its own difficulties and dangers of no little importance. Those who take choral habitually have irritable, injected, and rather brilliant eyes, and are voluble in speech, and have a rather excited and hurried manner. They complain usually of singing in the ears, of an empty or vacuous feeling in the brain, and are subject to sudden attacks of vertigo. They are wakeful, and very nervous and excitable, without chloral, when the time for sleep arrives, and they are usually entirely unable to sleep without the usual dose of the hypnotic. During the day they are melancholy, easily fatigued, and their voluntary movements are apt to be uncertain and disordered. The appetite is always capricious, frequently wanting; digestion is labored; the secretion of bile is deficient, the stools being rather white and pasty; the urine stained with the bile-elements, and sometimes albuminous.

An increasing weakness and irregularity in the action of the heart; dyspnoea, chiefly when the stomach is distended; redness, injection, and ecchymoses of the skin, have been occasionally observed to occur in cases of the chloral-habit.

The best method of managing these unfortunate cases consists in the very gradual diminution of the daily quantity of chloral; in regulation of the diet and administration of a suitable supply of food; air, exercise, and change of scene; chalybeate tonics; hyoscyamus and lupuline as calmatives, strychnine and picrotoxin as nerve stimulants; occasional purgatives

Therapy

Chloral is a remedy of great value in sea-sickness. From fifteen to thirty grains every four hours, the recumbent posture for a short time, and. suitable nourishment, are the most effective means we now possess for this troublesome disorder. In some cases of sickness of pregnancy chloral is equally effective, but, like other remedies for this condition, it often fails. According to the author's observation, it is most effective when there is much dizziness, faintness, and repugnance to food, and but little vomiting. When the odor of chloral invites nausea, as is not infrequently the case, it may be given advantageously by enema. And, furthermore, rectal injection of fifteen to thirty grains, properly diluted, is an effective remedy for nausea and vomiting of reflex origin, as occur in cases of uterine fibroids, gastroenteritis of children (Kjelberg), etc.

In severe cases of cholera-morbus, with cramps, coldness of the surface, cold breath and cold tongue, remarkable relief is procured, and the patient not infrequently wrested from a condition of extreme danger, by the hypodermatic injection of chloral. There is no means of treatment of cholera now known so effective as this, as the author has personally witnessed. The effectiveness of chloral is increased by combination with morphine. Rx Chloral, hydratis, 3 iij; morphinae sulph., gr. iv; aquae laur.-cerasi, oz j. M. Sig.: From fifteen to thirty minims —for cholera, cholera-morbus, etc. This injection produces considerable burning pain and an indurated lump, but in the author's experience suppuration has not followed.

As chloral produces a lowering of the temperature, and, according to Richardson, diminishes the coagulability of the fibrin, good results may be expected from its use in inflammations and fevers. It is especially indicated when the temperature is high and there are much delirium and restlessness present. The author has observed excellent results from its use under these circumstances in the eruptive fevers, pneumonia, etc. It should not be forgotten, however, that chloral must be prescribed with caution when there is ischaemia of the arterial system—a condition which must necessarily exist when a considerable portion of the lung-space is blocked up by fibrinous or caseous deposits. In pleuritis, endo- and pericarditis, and in peritonitis, much good will result from the use of moderate doses of choral—five grains every three hours. It is useful because it allays restlessness, causes sleep, lowers the fever, and limits or prevents fibrinous deposits and exudations.

The most important uses of chloral are in diseases of the nervous system. As an hypnotic, pure and simple, it is quite unrivaled. Cases of sleeplessness, due to mental overwork, anxiety, or physical fatigue, are entirely relieved by fifteen to twenty grains of chloral. The refreshing sleep thus obtained not infrequently leads to repeated and long-continued use of chloral, and thus the chloral-habit is formed. It follows that sleep should be procured by proper hygienic methods in such cases, if possible, and chloral should be resorted to only after the failure of such means. No hypnotic is so uniformly successful in procuring sleep in delirium tremens; but this remedy, as other remedies of the same class, not infrequently fails. It is more particularly adapted to those cases in which the delirium has succeeded to a debauch, and is less useful, and may, indeed, produce serious symptoms, in old, worn-out drunkards. Violent excitement not infrequently is produced by it when it fails to cause sleep. The author must caution his younger readers against the too large administration of chloral in this disease. Sleep may be procured which will end in fatal exhaustion. Especially should caution be used in the old drunkard, whose heart and vascular system may have undergone serious fatty and calcareous degeneration. In suitable cases there is no doubt chloral is a remedy of the highest value, but it should not be used to the exclusion of suitable hygienic and dietetic treatment.

Various forms of mania, in which delirium and wakefulness are prominent symptoms, are largely benefited by hypnotic doses of chloral. This remark is true of acute mania, acute melancholia, puerperal mania, acute maniacal delirium, and the excitement which occurs in general paralysis of the insane. When it agrees, and produces refreshing sleep, marked improvement in the mental state not infrequently follows its use. In incurable and intractable cases, chloral often renders the greatest service as a calmative and an hypnotic.

Puerperal convulsions, when the patient is in a condition to swallow, may be arrested by full doses of chloral—twenty grains every two hours; also, subcutaneously in five-grain doses, it is highly effective, according to Purefoy, and by the rectum its acts admirably in many cases. Infantile convulsions, when due to reflex irritation, may be suspended by the same means. When the jactitations of chorea are so incessant as to prevent sleep, or when they occur during sleep, chloral may be administered with advantage. It is not a curative agent in chorea, but when it produces quiet and refreshing sleep it indirectly contributes to the cure.