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.

Methyl Chloride, CH,CI,-a colorless gas, slightly soluble in water, of sweetish odor and taste, inflammable, burning with a greenish flame. Cold liquefies it, and the liquid boils at -7.6° F. It is used locally in neuralgia to produce intense cold, and with remarkable success.

Methylene Bichloride, Dichloro-methane, CH2Cl2,-is an effective anesthetic 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 anæsthetics 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 81) 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 3j 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 anæsthetic 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.

The result of the labors of the Hyderabad Chloroform Committee, conducted under the direction of Dr. Lauder Brunton, show that Chloroform and Ether act in the same way upon the heart and respiration, both paralyzing the respiratory centre before the heart,-Chloroform acting more quickly and more powerfully than Ether in both directions. This would necessitate that the person administrating chloroform as an anæsthetic should give his undivided attention to the respiration, the pulse being of secondary importance as long as the breathing is normal. Prior to this investigation it was taught that 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 82.]

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 condition 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 m v-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 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. f, with Atropine, gr. 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 82.

Syme administered Chloroform in five thousand cases without a single death therefrom. He ascribed this excellent record to his adherence to the following rule: "Never mind the pulse, never mind the heart, leave the pupil to itself, but keep your eyes on the breathing, and if it becomes embarrassed to a grave extent, pull the tongue well out with an artery forceps."

Dr. Sayre 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 31⁄2 per cent. of the anesthetic as the only safe proportion. Having been made familiar with the prac

tice 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.

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

"In this manner a very few inspirations will produce immediate anesthesia 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 re ports 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 six 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 as, the sea) because its most important members, Chlorine, Bromine and Iodine, are derived from the ocean, Chlorine being obtained from sea-salt, Bromine from sea-water, and Iodine from sea-weed. Chlorine itself is not official, but is represented in medicine by 2 Chlorates and 8 Chlorides (of Potassium, Sodium, Ammonium, Calcium, Iron, Gold, Zinc and Mercury), which are described under the titles of their respective bases; also by Hydrochloric Acid, Chloral, Chloroform, etc., and 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 disagree

CHLORUM.

177 able 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, ClO4, 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 147). 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 Chlorate, B. P., is a solution of I pound in 1 gallon of water.

Liquor Soda Chlorate, Solution of Chlorinated Soda, Labarraque's Solution,—a palegreenish liquid, of faint Chlorine odor, and alkaline taste and reaction; prepared by adding together watery solutions of Sodium Carbonate 100 parts and Calx Chlorata 80, each in 400 parts of water, then adding Water up to 1000. Contains Sodium Hypochlorite and Chloride. Dose, mx-3j in 20 parts of water.

PHYSIOLOGICAL ACTION.

Chlorine is actively irritant to the skin and mucous membranes. Locally applied it produces heat, burning and even vesication. Inhaled in any quantity it causes cough, sneezing and spasm of the glottis, also inflammation of the air-passages and of the lungs. It is the most powerful of all disinfectants and deodorants, also an antiseptic and antifermentative agent of the highest activity.. Its power in all these respects is due to its affinity for hydrogen, decomposing all bodies in which hydrogen enters as a molecular constituent, forming chlorhydric acid and setting oxygen free in its nascent form (ozone). Used internally it has the same local action on the parts with which it comes in contact, and on reaching the stomach in dilute solution it is converted into hydrochloric acid and chlorides, losing all further action on the body in its own character.

Antidotes.

Ammonium
ALBUMEN

AMMONIACAL VAPORS inhaled after Chlorine from Ammonium Chloride. Sulphide has a similar reaction, but should be inhaled in great moderation. is the antidote if Chlorine preparations have been taken into the stomach, and a little Aqua Ammoniæ, sufficiently diluted, may also be administered with advantage.

THERAPEUTICS.

The chlorinated preparations are used as disinfectants and deodorizers of rooms, drains and discharges from the body. They are rarely used about the person or clothing of patients by reason of the irritation produced by them when inhaled, and their power to destroy the color of fabrics. In dilute solution they are well employed as local applications in aphthæ, gangrene, scarlet fever and diphtheria, in which their principal action is to destroy fetor. The same may be said of their use in sloughing ulcers and gangrenous wounds, foul discharges, etc., as they are

rarely employed about the person in sufficient strength to have any destructive effect on disease-germs. A strong solution of Chlorinated Soda is a good application to bites of serpents and insects, to prevent infection. by the syphilitic poison, and to wash the hands after contact with infectious material.

A combination of Potassium Chlorate and Tinctura Ferri Chloridi, makes a solution of Chlorine, Euchlorine, Potassium Chloride and Ferric Chloride, when diluted with water, and gives one of the best and most innocuous solutions of antiseptics. It makes an excellent gargle for sore throats, simple or diphtheritic. Glycerin should never be added to it, as the resulting mixture will be liable to explode violently.

These preparations have been administered internally in septic diseases, low fevers, etc., but without producing any marked beneficial results.

To disinfect unoccupied rooms all means of exit should be stopped up, then a pound of Chlorinated Lime sewed loosely in a strong canvas bag is immersed in a mixture of a pint and a half of common muriatic acid with 41⁄2 pints of water, and left 24 hours.

CHONDRUS, Irish Moss,-consists of two sea-algae, Chondrus crispus and Chondrus mammilosus, dried and bleached. Is horny, translucent, pale yellowish-white, swelling in water, of sea-weed odor and mucilaginous, saline taste. On boiling with 30 parts of water for ten minutes it yields a solution which gelatinizes on cooling. It contains 90 per cent. of mucilage with traces of Iodine and Bromine, also 1 per cent. of Nitrogen. There are no official preparations. A jelly or blanc mange may be prepared by boiling zij in 3xxxiv of water for an hour, straining and adding 3iij of sugar while hot. Dose, indefinite.

PHYSIOLOGICAL ACTION AND THERAPEUTICS.

Irish Moss is a demulcent and nutrient substance of some slight value in bronchial and catarrhal affections. Having no starch in its composition it is not so valuable as Iceland moss (Cetraria) as an article of food for the sick.

CHRYSAROBINUM, Chrysarobin,-is a mixture of proximate principles extracted from Goa-powder, a substance found in cavities formed by decay in the wood of the trunk of Andira Araroba, a Brazilian tree of the nat. ord. Leguminosa. It is commonly misnamed "Chrysophanic Acid" (which is one of the constituents of Rheum)— though easily converted into that substance. Occurs as an orange-yellow powder, odorless and tasteless, nearly insoluble in water and alcohol, but readily soluble in ether, solutions of alkalies and sulphuric acid. gr.-gr. xx.

Dose,