Clinical observations on hydrate of chloral as a hypnotic in typhus / by James B. Russell.

  • Russell, James Burn, 1837-1904.
Date:
1870
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Licence: Public Domain Mark

Credit: Clinical observations on hydrate of chloral as a hypnotic in typhus / by James B. Russell. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    0 Physiological action of chloral.—Although the chloral was administered for therapeutic ends, the notes of these cases in some particulars illustrate the observations of Liebreicb, Bouchut, Personne, and Richardson, as to its physiological effects. The full development of these effects depends, of course, upon the dose; and since, from the papers of these gentlemen, I was led to exhibit at first what proved to be an overdose, viz., 40 grains, the action of the drug went further than was necessary. I therefore give the notes of two such cases in full. At the close of the paper will be found some speculations as to the cause of this susceptibility. Case I.—Janet N , aged 25, on 12th Dec., 1869, had been six days in hospital with very severe typhus of unknown duration, aggravated by debility from 15 months’ lactation. On the forenoon of that day, although her pulse was falling and her bowels were free, she had not slept for 14 hours, but had sung and talked constantly, and was only held in bed by the canvas sheet. 12.50 p.m.—Pulse, 120; good. Temperature in rectum, 100-5°. Face flushed and whole aspect excited. At this hour 40 grains chloral were given. 1.10 p.m.—Pulse, 118; decidedly smaller and softer, and indeed seems to falter at times. Lies quietly half on back; eyes shut; respirations interrupted by a constant short cough. Eyelid lifted without awakening patient; pupil almost pin-hole. On pinching arm severely she awakes, looks up, and pupils, at first small, become natural. Coughs, and dislodges a quantity of mucus. 1.30 p.m.—Pulse, 124. Housed by nurse, contrary to orders, to take milk, and is, though not restless, noisy. 2.20 p.m.—Pulse, 112 ; soft. Quiet; saying “ Awe ! awe !” in a dreamy tone. 3 p.m.—Pulse, 110 ; soft. Still more absent and drowsy, but repeating “ awe ! awe !” 3.40 p.m.—Pulse, 84 ; small, feeble, irregular. As before; tranquil. 4.20 p.m.—Pulse, 82 to 86 ; improved in quality, but irregular. Same dreamy tranquil state. Evidently alive to what is being said. Passed urine in bed. 5 p.m.—Pulse, 92 ; improved in quality, and rather steadier. General con- dition unchanged. 5.40 p.m.—Pulse as before; asleep, but wakened by counting it. Has had no food or stimulant since draught. Give milk. 6.20 p.m.—Pulse, 112 ; quality good, and quite regular. Temperature in rectum, 102,5°. No more sleep ; passive ; talking to herself. 8.20 p.m.—Pulse, 120; good. Quiet, but talking, and waving hands in air. 30 grains chloral in halfi-an-ounce of ivater and syrup given, but vomited at once. 11 p.m.—Pulse, 120. Excited, and constantly chattering. Give 40 grains chloral again, in *iss. water and syrup. 11.30 p.m.—Pulse, 116; much softer. Patient became quiet in about ten minutes after draught, and now sleeps calmly. Respiration is sometimes slow and full, sometimes hurried and short.