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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    necessary, especially in view of the readiness with which the chloral, like the natural sleep, may be broken and resumed. Indeed, the same rule applies here as to all the circumstances of a fever patient,—not to interrupt the regular administration of food for any cause, and remem- bering that we are dealing with a drug which has a special action on the heart, we should first be cautious in adapting the dose to the age and vigour of the patient; and then, having given it, should watch the pulse at intervals, more particularly during the next six hours. The mode of action of chloral.—This theoretical question assumes some practical importance when we employ chloral in typhus. According to Liebreich, the ultimate physiologi- cal action is not that of chloral, but of chloroform produced by the decomposition of chloral by the alkalies of the blood. This theory is strongly supported by the fact that chloral mixed with fresh blood does evolve chloroform. M. Personne and Dr Richardson agree with Liebreich. Indeed M. Personne has gone further in the proof of the theory by demonstrating the presence of chloroform in the blood of dogs, to whom chloral alone had been administered.* Now it is well known that the tendency of the typhus process, as it advances, is to increase the alkalinity of the fluids of the body. Ammonia can be detected in all the excretions in an amount much greater than in health. The urine, at the close of a severe case, gives off free ammonia so copiously as to cause lachrymation, and to be sometimes quite unbearable by one auscultating the back, for example, of a patient passing it involuntarily. “ There is good reason for believing,” says Murchison, “ that the unnatural fluid state [of the blood] in typhus results from an abnormal amount of ammonia.” Whatever may be the precise pathological product, there is no doubt of the fact that typhus blood is more highly alkaline than the blood in health. Hence, if its action depends upon alkalinity at all, and M. Personne seems to have demonstrated that fact, then chloral must be par excellence, the hypnotic suited for typhus. Liebreich’s theory is in itself beautiful and attractive, and * Gaz. Ilebd., November 19th, 1869.