Sufficient experience has now been gained with trional to establish it permanently in the group of hypnotics. It is closely allied to sulphonal, but it is much more prompt in action. Its effects begin in fifteen minutes to a half hour, and continue four to eight hours, according to the size of the dose. It is almost entirely free from unpleasant after disturbances, and does not cause nausea or other stomach distress, nor are confusion of mind and headache results of its impression on the brain. Like other hypnotics of this kind, trional has little power to relieve pain, which in turn affects the hypnotic action. Combination with other remedies of the same group promotes the action of each component of the prescription. This seems to be true especially of sulphonal and trional, as already explained. Dose, five to ten grains, in powder, wafer, or compressed pellet.

Chloralose is a new chemical product with this proprietary designation. It is obtained by the action of chloral on glucose, and is a crystalline substance. The dose ranges from two to five grains. It is said to be an excellent and certain hypnotic, producing its effect without causing any untoward accidents. Further experience is necessary to demonstrate its real place as a remedy.

Amylen Hydrate is, in chemical language, dimethyl-ethylcarbinol, a name too unwieldy for common use, and hence the present designation. It is a transparent, colorless liquid, having an odor of a disagreeable kind resembling paraldehyde, and a camphoraceous taste. The dose ranges from five minims to 3 j. The best vehicle for covering the taste is extract of licorice. For hypodermic administration it may be dissolved in distilled water, in oil of vaseline, or in chloroform water.

Amylen hydrate appears to have no local irritant action, and is feebly toxic. Very large doses have, it is true, caused stomachal disturbance, but ordinary medicinal doses are free from such effects. The action of the heart and respiratory movements are lowered by it, and febrile temperature is depressed from toxic doses; the reflexes are lessened in activity and ultimately abolished; the normal body-heat is reduced, and profound coma and insensibility ensue. From such a condition of coma and vital depression due to a mistake in the quantity of amylen hydrate given, some patients in the Leipsic Hospital recovered on the third day without any recognizable after ill-consequences. The hypnotic effect follows the ingestion of the remedy in a few minutes—from five to fifteen or twenty minutes—and is rarely postponed to an hour; and if produced by ordinary medicinal doses, no change takes place in the rhythm and force of the cardiac movements, nor in the respiratory movements.

Von Mering, whose experience was gained in Jolly's clinic, was the first to ascertain the powers of amylen hydrate as a hypnotic. Scharschmidt found it to be successful in eighty per cent of his cases as a hypnotic, the subject of these experimental trials being in the clinic of psychiatry. The duration of the sleep is usually six to eight hours. Two to four grammes (30 to 60 grs.) were prescribed on the first trials, but subsequent experience shows that a less amount—from five to twenty grains—will usually succeed in procuring sound sleep of several hours' duration. The existence of pain and other systemic disturbances will interfere with its action.

Amylen hydrate apparently deserves attentive consideration as a hypnotic. Where insomnia is the main condition and no other sources of disturbance exist, it is one of the most promising remedies. In the insomnia of mental disorders, Krafft-Ebing has prescribed it with success. By Von Mering it has been used in delirium tremens with distinct advantage. Dr. Wildermuth has employed it in epilepsy, and finds it exceptionally useful in cases of the grand mal, especially when nocturnal. He found it also to have great utility in the removal of bromism, while at the same time it prevented, the recurrence of the epileptic paroxysms.

In various spasmodic and vaso-motor neuroses, such as asthma, singultus, whooping-cough, tetanus, strychnine poisoning, it has afforded great relief. The condition of muscular cramp is an indication for its use. Although not an analgesic, it relieves pain indirectly by allaying the cramp which is the cause of pain. In this way it brings about relief to hepatic colic, and also, it is said, removes the catarrhal state of the mucous membrane which is the cause of the accompanying jaundice.

Chloretone is a white crystalline substance having a camphoraceous appearance and odor. Its composition, according to Willgerodt, is

CH3

CCl3—C—OH,

CH3

and is therefore a trichlor tertiary butyl alcohol.

Chloretone is sparingly soluble in cold water, but is freely soluble in ether, chloroform, acetone, and strong alcohol.

It may be administered in pill, capsule, or powder, and may be inhaled in the form of vapor. When introduced into the stomach or injected subcutaneously or intravenously, or its vapor inhaled, it passes into the blood quickly and diffuses through all parts of the organism. In actual contact with the tissues, it lowers sensibility, ultimately suspending the pain-sense and causing complete anaesthesia if the amount applied is sufficient. As a local anaesthetic its effects are closely allied to those of cocaine. It has a selective action on the brain and nervous system, from which it is obtained in larger quantity than from any other part of the body. It does not affect the composition of the blood nor act on the blood-globules, nor on the haemoglobin. As regards the circulation, the effects are not those of a depressing agent; the blood-pressure usually remains unaffected and the amplitude of the pulse-wave continues undiminished.

Chloretone administered in any way causes hypnotism and anaesthesia. The functions of the brain, cord, and neurons are ultimately suspended if the amount ingested has been sufficient. It is not eliminated in the form in which it is taken, and does not appear as chloretone in the expired air and in the urine. As the relative proportion of chlorides in the urine is increased by its administration, it is probable that it undergoes oxidation in its passage through the system.

Chloretone is distinctly antiseptic, preventing the decay of organic matters, both solid and fluid, by destroying the organisms concerned in putrefactive decomposition. A solution of five per cent is sufficient to prevent change in organic fluids and to render sterile instruments and vessels.

The therapeutical applications of chloretone are based on its physiological actions. As it is not actively toxic, the dose ranges from 5 to 20 grains, in pill, or tablet, or wafer. As a local application the finely divided powder may be used, or a half-per-cent solution, or, vaporized by heat, it may be inhaled cautiously.

It is a useful local antiseptic and anaesthetic in cases of wounds and injuries requiring such an agent. Internally, in cases of nausea and vomiting, seasickness, ulcer of stomach, vomiting of pregnancy, and similar conditions, it is an efficient remedy.

Chloretone is indicated in insomnia due to painful affection, for it is anaesthetic as well as hypnotic. To procure the best results from its administration in cases of insomnia, it should be given several hours before the expected period of wakefulness.