CHLORAL BUTYLICUM-CHLOROFORMUM.

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in colic, cholera and cholera morbus, especially if combined with Morphine.

CHLORAL BUTYLICUM, Butyl-chloral Hydrate, Croton-chloral, C,H,CI,O,H,O (Unofficial), -is formed by the action of Chlorine upon Aldehyde, then adding to the ButylChloral thus produced the necessary water. It occurs in crystalline scales, insoluble in chloroform, sparingly soluble in water, but freely soluble in alcohol, hot water and glycerin.. Dose gr. v-xx, in syrup or pill. But the best method is to give 5 grains every half-hour until 20 grains have been taken or relief afforded.

Physiological Action and Therapeutics.

Croton-chloral so far as is ascertained has an action parallel to that of Chloral Hydrate, but feebler and less certain. It is said to have a specific paralyzant power over the 5th nerve, and to have no paralyzant effect on the heart. It has been used with benefit in various neuralgiæ, especially tic-douloureux, also in sciatica and dysmenorrhoea. All statements of the action and therapeutics of this drug are to be received with hesitation, as wide differences are reported by the best authorities.

CHLOROFORMUM, Chloroform, CHCl,,-the Terchloride of Methyl, or the Chloride of Bichlorinated Methyl, is formed by the substitution of 3 atoms of Chlorine for 3 of Hydrogen in Methyl Hydride (marsh-gas, CH). In practice it is obtained from Ethylic Alcohol or Methylated Spirit by the action of Chlorinated Lime, or from Chloral by an alkaline hydrate, and is known chemically as Normal Chloroform. If prepared from Methylic Alcohol (wood-spirit) it is called Methylic Chloroform and is purified with great difficulty. The object of purification is to remove the chlorinated pyrogenous oil. Absolute Chloroform has a sp. gr. of 1.500, and decomposes easily in sunlight or diffused daylight, but when reduced to a sp. gr. of 1.485 to 1.490 by alcohol it will keep well. It is official in two forms, viz.—

CHLOROFORMUM VENALE, Commercial Chloroform,—is a liquid containing at least 98 per cent. of Chloroform, and having a sp. gr. not lower than 1.470. It contains sundry Hydrocarbons, free Chlorine, Aldehyde and Hydrochloric Acid, and is used only for external applications, or to make the purified article. It is a constituent of Linimentum Chloroformi.

CHLOROFORMUM PURIFICATUM, Purified Chloroform,-is a

heavy, clear, colorless, diffusive liquid, of characteristic odor, sweet, burning taste and neutral reaction, soluble in 200 of water, freely so in alcohol or ether, also in oils, benzol or benzin. Sp. gr. 1.485 to 1.490 at 59° F., and contains 3/4 to 1 per cent. of alcohol. Dose, internally, mij-xx, for inhalation about 3j, repeated until the desired effect is produced.

Preparations.

MISTURA CHLOROFORMI,—contains of Purified Chloroform 8, Camphor 2 fresh Yolk of Egg 10, Water 80 parts. Dose, zj-3j.

SPIRITUS CHLOROFORMI,-Contains of Purified Chloroform 10, Alcohol 90 parts. Dose, mx-3j, well diluted.

LINIMENTUM Chloroformi,-Commercial Chloroform 40, Soap Liniment 60 parts.

LINIMENTUM CHLOROFORMI COMPOSITUM (Unofficial),-Chloroform 3j, Oil of Turpentine 3j, Tincture of Opium ziv, Tincture of Aconite zij.

CHLORODYNE (Unofficial),—a celebrated secret mixture, put forth by Dr. J. Collis Browne, of London, and since imitated by many others. It is supposed to contain Chloroform, Ether, Morphine, Cannabis Indica, Hydrocyanic Acid, Capsicum, etc., and is powerfully anodyne, antispasmodic and narcotic, and therefore highly dangerous in non professional hands. Do e, mx-xxx, according to the quantities of Morphine and Chloroform present, these being the active agents in the preparation. A comparison of the principal formulæ which have been used in imitation of Browne's Chlorodyne is given in the appendix, and will show the wide differences between them. A list of 25 formula for Chlorodyne was published in the Therapeutic Gazette for October, 1883.

ANESTHETIC MIXTURES containing Chloroform,-see under ÆTHER, ante, page 44.

Some Chlorinated Anæsthetic Compounds.

ETHYLENE BICHLORIDE, Dutch Liquid, Chloric Ether, C,H,C,,-is a rapid and powerful anesthetic, probably safer than Chloroform and less so than Ether. It always paralyzes the respiratory centre before the heart, so that its effects may be easily watched and controlled. This is the substance which Guthrie supposed he had obtained when he discovered chloroform.

ETHYLIDENE CHLORIDE, Chlorinated Muriatic Ether, CH,,CHCl,,—is a mixture of varying sp. gr., and is not inflammable. It closely resembles Chloroform both physically and physiologically, but is less depressant to the heart, consequently safer, and recovery from its effects is very prompt.

METHYLENE BICHLORIDE, Dichloro-methane, CH,C,,—is an effective anæsthetic which it was supposed would displace Chloroform as being much safer. Dr. Richardson introduced it and Mr. Spencer Wells advocates its use, but though little used as compared with other anaesthetics several deaths have occurred from its employment. It kills by paralyzing the heart.

CARBON TETRACHLORIDE, CCI,-is less irritant than Chloroform, but far more dangerous to the heart.

Physiological Action.

The action of Chloroform is similar to that of Ether (see ante, page 44) with several important differences, as follows: It is more

irritant to the mucous membranes, and if swallowed undiluted it produces violent gastro-enteritis, which becomes apparent after the subsidence of the profound narcotism which at first follows its ingestion in quantity. A dose of j internally will cause death. It is less of a stimulant than Ether, and more depressant to the heart and circulation. It clots blood outside the body, making a mass like sealing-wax.

Inhaled for anesthetic purposes it is considered much more dangerous than Ether from its direct paralyzant effect on the heart. Its vapor requires admixture with 961⁄2 per cent. of air to produce anesthesia with safety according to the authorities on the subject. As compared with Ether its vapor is less irritant to the air-passages, uninflammable, more pleasant, more prompt in action, has a shorter stage of excitement and a more profound narcosis, and produces much less vomiting. Its mortality is greater, being 1 in 3000, against 1 in 16,000 for Ether, about 500 fatal cases being reported, none of which, however, were in obstetrical practice. Death from Chloroform-inhalation is almost always sudden and by cardiac paralysis,-from Ether it is slow and usually by paralysis of respiration.

[For modes of death from anæsthetic vapors, and the treatment of dangerous symptoms, see ante, page 45.]

Antagonists.

There is no chemical antidote. If swallowed, the stomach should be evacuated and the case treated as one of poisoning by an irritant. Amyl Nitrite by inhalation, and Atropine hypodermically, to sustain the heart.

Therapeutics.

Chloroform is used for the same conditions as is Ether, and is much employed in liniments as a rubefacient and anodyne application, as in pruritus, rheumatic and neuralgic pains, etc. Internally it is advantageously administered in true cholera, in which it has been more efficacious than any other single remedy, in cholera morbus, vomiting, colic, dysmenorrhoea, hepatic colic, and other pains of internal and spasmodic character. In sciatica, tic-douloureux and other neuralgia of important nerves the deep injection of mv-xv of pure Chloroform in the vicinity of the nerve is highly recommended, though it may cause dangerous local disturbance. The writer has, in several cases of severe supra-orbital neuralgia, injected two or three minims of Chloroform into the vicinity of the supra-orbital nerve just above its foramen of exit, with the most gratifying results, though severe local pain and considerable swelling were experienced for several

days. The vapor in small quantities inhaled from warm water is useful in many respiratory neuroses, as hay-fever, spasmodic asthma, reflex cough.

As an Anæsthetic the use of Chloroform is decreasing every year in favor of Ether, except for young children and in obstetrical practice. Its vapor being four times denser than air, and the rule for its effective use requiring fully 961⁄2 per cent. of air with it, its administration according to the orthodox fashion requires most careful management, and should never be attempted in any but the recumbent posture. An ounce of Brandy and a hypodermic injection of Morphine, gr., with Atropine, gr. To, given 20 minutes before commencing the inhalation, are means of great utility in sustaining the heart and respiration, as well as in rendering the anesthesia more profound. No operation, especially on parts supplied by the fifth nerve, should be undertaken during partial chloroform anæsthesia, for the reasons given on page 45.

Dr. Sayre of New York administers Chloroform in a manner which is calculated to strike terror to the heart of an emotional observer who is impressed by the orthodox rule of 96% per cent. air with 32 per cent. of the anaesthetic as the only safe proportion. Having been made familiar with the practice of Dr. Sayre through observance of the method employed by some of his pupils, the writer sought for more direct instructions from that distinguished surgeon, and received from him a letter from which the following paragraphs are extracted.

"I have employed no other method for more than twenty years, have used it in this manner in some thousands of cases without the least appearance of danger, and can therefore speak with confidence as to its safety.

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My plan is simply to anæsthetize the patient with the smallest amount of Chloroform possible; and as Oxygen is the ANTIDOTE to the anesthetic I exclude all air that is not impregnated with the anesthetic.

"In this manner a very few inspirations will produce immediate anæsthesia without the muscular struggling which always follows when pure air is admitted with the chloroform. I always measure my dose with the same care as if I were administering Arsenic, Strychnine, Corrosive Sublimate, or any other potent agent; and then I know what I am doing. If by accident there should be some peculiarity about the patient, making him unduly susceptible, a few artificial respirations would soon remove the influence of the few drops which had been inhaled, and thus all danger can be avoided. Five, ten or twenty drops of Chloroform administered in this manner is all that is requisite to produce immediate and profound anesthesia. I have explained my method hundreds of times at my clinical lectures in Bellevue Hospital, many of which have been published at different times in different medical journals by various persons who have made stenographic reports of my lectures. In the Transactions of the International Medical Congress,' held in Philadelphia in 1876,

·

is a verbatim report of my remarks on this subject made while I was performing an exsection of the hip-joint in the hospital before the Congress." I remain, yours truly,

LEWIS A. SAYRE.

The writer can add his testimony to that of the above letter respecting the thorough anæsthetic effect and freedom from unpleasant symptoms observed in a large number of cases in which Chloroform was administered in the manner described under his observation during the past three years. As to the safety of this method over the ordinary way no conclusion can be reached without the results of many thousands of examples in the hands of many different observers.

CHLORUM, Chlorine, Cl,-is a greenish-yellow gas having a suffocating odor and belonging to the group of Halogen elements, so named (from 5, the sea) because its most important members Chlorine, Bromine and Iodine are derived from the ocean, Chlorine being obtained from sea-salt, Bromine from seawater, and Iodine from sea-weed. Chlorine itself is not official, but is represented in medicine by 2 Chlorates and 2 Chlorides (of Potassium, Sodium, etc.), which are described under the titles of their respective bases, also by the following preparations which furnish it.

Preparations.

AQUA CHLORI, Chlorine Water,—is an aqueous solution of Chlorine, containing at least 0.4 per cent, of the gas; and is prepared by heating together Black Oxide of Manganese 10 parts and Hydrochloric Acid 40 parts, then saturating 400 of distilled Water with the gas so obtained. It is a clear, greenish-yellow liquid, of suffocating odor and disagreeable taste. Dose, 3j-3ss, well diluted, as a lotion or spray; internally, mx-xx in water.

Chlorine Water may be extemporaneously prepared by mixing in a mortar Chlorate of Potassium 40 grains and Hydrochloric Acid 1⁄2 ounce, and adding a pint of distilled water by agitation during the evolution of the 'vapors. If done in a closed vessel danger may arise from the explosive gas, C12O1, which is liberated at the same time. It should be quickly bottled.

CALX CHLORATA, Chlorinated Lime, Chloride of Lime,-is a compound resulting from the action of Chlorine upon Calcium Hydrate, and containing at least 25 per cent. of available Chlorine. It is obtained by exposing slaked Lime to the action of Chlorine gas as long as the latter is absorbed, and should not be confounded with Chloride of Calcium (see ante, page 111). It occurs as a whitish, dry powder or friable lumps, gradually decomposing in the air, of saline, disagreeable taste and a feeble Chlorine odor, partially soluble in water and in alcohol, and when dissolved in dilute Hydrochloric acid gives off Chlorine gas. Dose, gr. iij-vj in water; for external use a 1 to 3 per cent. solution. LIQUOR CALCIS CHLORATÆ, B. P., is a solution of 1 pound in I gallon of water.

LIQUOR SODE CHLORATE, Solution of Chlorinated Soda, Labarraque's