BUTYL OR CROTON CHLORAL-PARALDEHYD.

383

should be well diluted and the somewhat acrid taste covered by a syrup or simple elixir. It is well absorbed from the rectum, and may very conveniently be administered by enema, thus avoiding the disagreeable taste. In this case, also, it should be given in dilute solution. Combinations should be made by the physician and not by the wholesale druggist. Suppositories can be used. Experience has shown that the doses of chloral proposed when it was first introduced into practice were much too large, and the tendency has been decidedly to reduce them. Hence we may say that when administered to an adult for the first time the

DOSE is from eight to fifteen grains, half a gramme to a gramme (0.5 to 1), which may be once or twice repeated. Under special circumstances, like alcoholism or convulsions, the commencing dose may be larger-twenty to thirty grains, a gramme and a half to two grammes. For children a proper dose is one grain, six centigrammes (0.06), for each year of age. [BUTYL or CROTON CHLORAL.]

C,H,C,O,H2O. A colorless oily fluid.

Was said to differ from chloral in having a special action upon the trifacial nerve and less depressing effect upon the heart, and was recommended for use in facial neuralgia and headache as well as for the more ordinary purposes.

Experience, however, does not assign to it all the advantages claimed, and, as it is more difficult of solution and more disagreeable in taste, there is no good reason for retaining it in use as a substitute for the other. It may, however, be used in cases of facial neuralgia and headache. It may be dissolved in wine, alcohol, or glycerine, and the taste partly covered by a syrup.

[PARALDEHYD.]

(CHO). Soluble in 60 parts of cold water. Fluid at ordinary temperature of rooms, of a strong, penetrating, disagreeable odor.

It has been used considerably as a hypnotic. Its action is not altogther certain, but it is often effectual and seems to leave. behind no unpleasant effects except the pungent smell of the breath. So far as known, it is safe in reasonable doses, although very large ones stop first the respiration and then the heart. An erythematous eruption has been seen after its use. Cerebral congestions and vaso-paralytic effects have been attributed to its prolonged administration.

The DOSE is from twenty to sixty drops.

384

URETHAN-HYPNONE-METHYLAL.

[URETHAN.]

NH2CO2C2H. Carbamide of ethyl. Crystals easily soluble in water, with a not unpleasant taste, like nitrate of potassa.

This drug produces a sleep nearly resembling the natural, coming on in less than an hour after the dose and lasting several hours. There are no unpleasant after-effects. The pulse, respiration, and digestion are not affected. Its influence is exerted upon the brain and not upon the sensitive nerves, so that in cases where sleeplessness is due to external irritation, as in the cough of phthisis, it is not so useful.

It has been found in animals an antidote to strychnine so that it may prove of value in convulsive diseases in man.

It can be given subcutaneously in smaller doses.

DOSE.-Fifteen to sixty grains, one to four grammes, in simple

solution.

[HYPNONE.]

Phenyl-methyl-acetone. CH,COCH3. (CgHg). Colorless, very mobile, very refractive liquid, not soluble in water or glycerine; soluble in alcohol, ether, chloroform, benzine, and naphtha.

It is eliminated by the lungs and kidneys.

It is a hypnotic of very moderate power without unpleasant after-effects. Large doses produce coma with cardiac and respiratory paralysis. The breath has a disagreeable odor. Its hypnotic action notably augments the anæsthetic effect of chloroform. On account of its insolubility in water the best method of administration is in capsules.

DOSE.-Five to fifty centigrammes (0.05 to 5), five-sixths of a grain to seven and a half grains.

METHYLAL.

Light, colorless, volatile fluid, of a pleasant, aromatic odor. Easily soluble in water, alcohol, and oils.

Produces sleep, profound, but of short duration. There is some anesthesia and diminution of reflex action. It has a depressing effect upon the heart, respiration, and temperature.

It is given by the mouth in the DOSE of four minims (twentyfive centigrammes) repeated until four doses (one gramme) have been taken.

SECTION XXIV.

GENERAL NERVOUS SEDATIVES.

POTASSII BROMIDUM-Bromide of Potassium.

Bromure de Potasse; Kalium Bromatum; Bromkalium, G.

KBr. 118.8. Colorless, translucent, cubical crystals, permanent in dry air, having a pungent, saline taste. and a neutral reaction. Soluble in 1.6 part of water, and in 200 parts of alcohol at 15° C.

Bromide of potassium has a disagreeable, strongly saline taste, and in large dose and too strongly concentrated solution is likely to cause nausea or pain in the stomach. It is absorbed from the stomach and rectum, and in a cold bath in small quantity from the skin. It is eliminated unchanged, chiefly by the urine.

Small doses of the bromide, even several times repeated, give rise to no very marked effects, except sometimes to a little quietude, diminution of restlessness, and, if the patient is perfectly quiet and undisturbed, a slight inclination to sleep. There is no effect upon the pulse, except that which goes with rest. Upon the pupils or upon the secretions, none except perhaps a little diuresis. Larger doses, fifteen to ninety grains, one to six grammes, produce, according to the susceptibility of the person, a more or less decidedly quieting effect, and sleep is more sound and less liable to be disturbed by noises or trifling interruptions. A person sleeping under the influence of a full therapeutic dose can, however, be roused without difficulty. A not unpleasant prickling or tingling sensation over the whole body, about half an hour after the dose, has often been experienced by the author. There are no unpleasant sensations or depression on awaking, but usually a copious flow of urine.

Acute fatal poisoning from the bromide alone is unknown. In an unpublished case communicated to the author, four ounces of bromide, taken within forty-eight hours, were followed by profound comatose sleep, marked cutaneous anesthesia, and inability to swallow, lasting for fourteen days. The pulse was at first about eighty, and strong, but afterward became feeble. The respiration was also feeble. After some days large quantities of mucus collected in the fauces. This slowness of action distinguishes it strongly from most narcotics.

386

POTASSII BROMIDUM.

The most decided effects are those which follow a continued dose. Among them are acne, diminished reflex sensibility of the fauces and of the genito-urinary organs; a slow and feeble pulse, aphonia, nauseous breath, congestion of the fauces, a hoarse cough, tottering gait, with a feeling of great weakness on trying to walk; loss of mental activity, though this is rather a want of desire than of ability to think; and, finally, some hallucinations, and mildly maniacal attacks. Death is not certainly known to have occurred from bromide of potassium alone, although it has undoubtedly had a share in fatal narcotism. Attention has been called to the great similarity which may exist between chronic bromism and the general paralysis of the insane, and the possibility of bromism obscuring and compli cating the symptoms of cerebral disease in such a way as to lead to an unduly serious prognosis.

Besides acne, an ecthyma-like eruption and cutaneous ulcers very difficult to heal so long as the bromide is continued, may make their appearance. The administration of Fowler's solution or of tincture of cinchona is said to diminish the liability to these troublesome eruptions.

This bromide is undoubtedly a general nervo-muscular sedative, with a peculiar affinity for the reflex motor and cerebral centres. The susceptibility of the cortex to electrical stimulation is diminished or entirely destroyed, while that of the subjacent white substance remains unchanged. It has been suggested that bromide of potassium produces its effects solely as a potash salt, and that all its symptoms are to be explained by the depressing action which all potassa salts in very large doses exert upon the heart. It is possible that the potassium does have an effect upon the heart when the salt is given in very large doses; but the amount of any potash salt required to act notably on the heart is larger than the ordinary doses of the bromide, and no other potash salt produces the same effect upon the nervous system. Moreover, the action of bromide of potassium is like, though probably more intense than, that of the other bromides and of hydrobromic acid.

The uses of bromide of potassium cover a great multitude of diseases, but the indications for its exhibition are quite definite. Nervous over-excitability may be stated in a general way as the condition calling for it.

The following are some of the special conditions in which experience has shown it to be of value: In headache, especially if arising from overwork or excitement, or occurring in the course of continued fevers, a single dose, or better, two or three at short intervals, and amounting to from two to eight grammes altogether, may give great relief, especially if it be possible to administer the doses at or near bedtime, when the patient is no longer liable to disturbances. In sleeplessness occurring under similar circumstances to those mentioned, the bromide may be

POTASSII BROMIDUM.

387

given in the same way, although it may often require the assistance of some more powerful drug. In delirium tremens and that condition of nervousness immediately preceding its complete development, chloral and bromide are often given, the latter being in double proportion, and the dose being regulated chiefly by the chloral.

For the noisy and restless insane the bromide alone, or in the combination just named, or with Cannabis Indica, is of great value; but insanity with depression or melancholia is not so likely to be benefited. If pain is present, opium may be indicated, and the bromide, under these circumstances, sometimes converts the painless but sleepless night into a much more refreshing period of slumber. The bromide is one of the best corrigents of morphine, and should be given, if possible, two or three hours in advance of the opiate.

Genital excitability may be much influenced by the continued dose, which is to be employed in spermatorrhea, in hysteria, and in some kinds of neuralgia connected with disturbances of the sexual function. The nervous disturbances attending the change of life are greatly relieved by it.

In ordinary neuralgia it is not likely to be of much value.

In some spasmodic affections, such as tetanus and strychnia poisoning, it would be clearly indicated, if it were not for the slowness of its action relative to the rapidity of the poison or the disease. Tetanus, however, has been very successfully treated by it, and even a case of strychnia poisoning. Various spasmodic diseases of children, such as chorea and whoopingcough, have been benefited by it in conjunction with other drugs, especially tonics. Convulsions are often treated by it, though generally more powerful and rapidly acting drugs are used in its place or with it.

Epilepsy is the most signal triumph of this drug, especially the cases where the fits are fully developed and occur in the daytime. Petit mal and nocturnal epilepsy, though perhaps favorably influenced, are not so fully controlled by it. In the former cases, haut mal, a few are cured permanently, others for a greater or less number of years or months. Others have no fits so long as the bromide is continued, and in almost all the number of fits much diminished, while a small minority receive no benefit. In epilepsy the bromide is to be given until the symptoms are distinctly checked, or the condition of bromism becomes not only unpleasant but dangerous. Reflex anæsthesia of the fauces, or the non-occurrence of gagging when the back of the pharynx is touched with a spoon, has been suggested as a useful practical test of sufficient bromization. It must be continued, supporting the patient's general health in the meantime, for months or years. The action of bromide upon the heart, either direct or through the spinal centres, is often of value, as in nervous palpitation or in exophthalmic goitre. Much care should be exercised in giving large doses of narcotics to a patient fully bromized.