Chloretone is one of the best of the hypnotics. U-sual dose is from 3 to 5 grains at bed-time. It is best given dis solved in alcohol or whisky and followed by a glass of milk. F. F. Ward (Med icine, vi, p. 642, 1900).
There is no other efficacious, practical antiseptic that is so conspicuously anTs thetic chloretone, when applied locally, and at the same time so utterly devoid of any harmful effects, either local or constitutional. T. A. Dewar (Therap. Gaz., Feb. 15, 1900).
Chloretone is especially recommended as an hypnotic and local amesthetic. There are no depressing after-effects, and it is safe to administer larg,e doses. Ten to 15 grains, repeated in two hours if necessary, is the usual dose. AV. M. Donald (Ther. Gaz., vol. xvi, No. 1, p. IS, 1900).
Chloretone is the safest of all hyp nodes. It should be given in from 15 to 20-grain doses in severe cases, and repeated. often enough to produce the desired effect. For hypodermic use, a saturated solution of chloretone in a, mixture containing 15 per cent. of alco hol and S5 per cent. of water is suffi ciently strong to produce local ancesthesis for minor operations. A still more powerful local amesthetic may be pro duced by mixing equal parts of chlore tone and ether. This is particularly use fill to dentists as an application to the nerve-pulps -when it is advisable to re move them. W. 11. Hill (N. Y. Med. Jour., Aug., 1900).
Toxic and Untoward Effects.—The toxic and untoward effects, except as has heretofore been stated, are practically identical to those of all chloral deriva tives. It is believed that most of the untoward results arising during the ad ministration of medicinal doses are due to impurities,—chlorinated substances,— and, fortunately, such are rare. These are, for the most part, disturbances of respiration, including dyspncea and par tial asphyxia; irregular action of the heart; irritation of the conjunctiva; swelling of the epiglottis and falSe vocal cords; icterus, increased jaundice; bed sores (rarely); dimness of vision, per haps even temporary blindness; ery thematous, urticarious, and eczematous rashes, etc.
What constitutes a poisonons dose is not known, since so small an amount as '20 grains has induced fatality, while, on the other hand, I have known of the ingestion (by accident) of 4S0 grains without any ill effects succeeding. Death may arise from cardiac syncope, from paralysis of the respiratory centre with coma and gradual suffocation, or from excessive depression of bodily tem perature; a series of cases are recorded in which were evinced symptoms akin to blood-poisoning with purpuric and scorbutic eruptions, ulceration of gums, and great prostration, leading to death.
Treatment of Poisoning.—First, stimu lants to the heart and respiration, and, second, attempts directed toward in creasing temperature. Strychnine has been heralded as a physiological anti dote, because it is antidoted by chloral, but this premise is, unfortunately, not a safe guide; atropine and amyl-nitrite (by inhalation) are more reliable agents; yet strychnine may be valuable as a means of sustaining the action of the heart.
Case of a middle-ag,ed man who was in a mental state bordering on melancholia, due to worry and the use of alcohol. Choral-hydrate, 40 grains, and potassium bromide, 15 grains, were directed every three hours, with a double dose at bed time. Prescription was written on Thursday, and the patient AA-as not seen again until the following .Monday. Ile was then found in bed with his knees and chin approximated; the extremities cold, and he was jerking and rolling about. Breathing was slow and sterto rous; pulse was slow and soft; face was ashen gray, with parched lips and swollen tongue; there was marked stupor. Since the prescription had been given he had had the prescription filled four times, and had been drinking half a small glassful at a. (lose. During the time lie had eaten heartily and had taken little or no alcohol. It is estimated that (luring the three days lie had taken no leqs than S ounces of the mixture, or 940 grains of chloral and 960 grains of potas sium bromide. Recovery Avas rapid under stryehnine. P. F. Rogers (Med. Record, Mar. 10, 1900).