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Chloralamid, or more properly chloralformamide, is, therefore, a pure hypnotic. The drug is a chemical union of chloral anhydride with formamide. It is soluble in water (10 to 14 parts) and alcohol (1 to 14 parts).

[ While chloralamid may dissolve in 10 to 14 parts of water under manipulation and after considerable time, it is safer to use 20 to 25 parts of water-always cold, never hot.]—Ed.

When introduced into the alimentary canal it is quickly absorbed and passes into the general circulation, where it is gradually broken up with the liberation of chloral. The existence of free chloral in the organism would, if in sufficient quantities to produce hypnotic effects, lower the cardiac and respiratory action by direct effect on the ganglia governing these functions, which is not to be desired in many cases. When in combination with the formamide, as in this drug chloralamid, these functions of the medulla are stimulated, and the depressing influences of chloral counteracted.

The effects of this drug on the nervous system other than the production of cerebral anemia—sleep—and the lessening of irritations to a certain degree, are practically nil.

Its influence on respiration is decided. In ordinary doses it stimulates the respiratory center and greatly depresses it in toxic quantities—death resulting from paralysis of respiration and not from cardiac failure as in chloral poisoning.

The sphygmographic tracings show that the blood pressure practically remains uninfluenced except just before death, when it is diminished about nine-tenths () of the total pressure; this seems to be from cardiac enfeeblement rather than from any influence on the vaso-motor system.

Slight influence, if any, is exerted on digestion, temperature, appetite or secretion of urine.

The chief therapeutic indication for the employment of this drug is in diseases, organic and functional, where hypnotics are required for insomnia, except when it is the result of great mental excitement or pain, and even in these cases it will often ameliorate the condition. It is especially useful in the insomnia from high arterial tension in Bright's disease. Its range of usefulness is, therefore, very large, for insomnia is a very distressing symptom of a large number of disease-processes.

Its stimulating effect on respiration would specially indicate its use for the night-sweats of phthisis. The depression following this condition does not seem to be due to the sweating per se, but rather to the effects of a gradual increase in the quantity of carbonic acid gas in the blood incident to the dificult interchange of gases from the pulmonary lesion. In phthisis, when the daily exertion from excessive coughing or other physical causes more than exceeds the supply of energy and nutrition which can be furnished by the body, the respiratory centers are greatly depressed, and not so quickly stimulated by a quantity of carbonic acid gas in the blood which ordinarily would affect them. The sweat centers are not affected by the physical causes, and respond to the stimulation of the increased amount of carbonic acid and pour forth their secretions abundantly. A respiratory stimulant would combat this functional perversion, and as this kind of a therapeutic agent we can recommend chloralamid,

When the drug is given for its hypnotic effect its physiological action is noticed in from thirty (30) to ninety (90) minutes, and the sleep induced lasts from five (5) to nine (9) hours, is natural and refreshing and not followed by any unpleasant sequelæ. No symptoms of cerebral congestion or any unpleasant sensation in the head or other parts of the body are experienced. No evil effects followed the continued use of the drug for ten (10) days, and during this time it was not neces. sary to increase the dose, nor was its hypnotic effect diminished. Any pyschological influences can, therefore, be eliminated. There is no cumulative action of the drug, nor are there any cases on record where a habit has been formed. The best time for administering the drug is just before retiring. It can be given in capsule, dry on the tongue, as an enema, or preferably in solution. As palatable a combination as one could wish is the following, which will be found useful in private practice. It is a pleasant mixture with a slightly acid taste: R Chloralamid, 3ij; tr. cardamom co., zi; misce bene et adde syr. aurantii, syr. rubi. idæi, aa Zss. M. et sq.: from one-halfto one tablespoonful repeated. The dose which yields the best result is from thirty to forty-five grains. Not more than one hundred grains should be given in 24 hours.

The conclusions, based upon its use in two hundred and eighty cases, are briefly as follows:

That it is a most useful hypnotic, reliable, safe and pleasant. That it has a place as an anhydrotic in phthisis.

That it is superior to other drugs because in hypnotic doses it stimulates respiration, and but slightly, if at all, influences pulse, temperature, or urinary secretion.

That no collateral symptoms of any consequence exist. That the best hypnotic dose for an adult is forty grains.

That it is given preferably in an alcoholic solution just before retiring.Brooklyn Med. Jour.

Uric Acid Diathesis in Children.

Dr. Sutherland contributes a short but suggestive paper upon this subject in a recent number of the British Medical Journal.

Under the heading“ Symptoms Due to the Presence of Uric Acid in the System,” he says :

“ The subjects of the diathesis are often easily recognized. They have keen, precocious minds, and small, restless bodies ; they are excitable, nervous, bright and amusing at one time, and greatly depressed at another; they do not readily fall asleep at night, often talk in their sleep, and have a habit of awaking in the very early morning; and they are dainty feeders, with a taste for everything that is bad from a nutritious point of view. The children are often described by their parents as being very subject to colds, and a chill in some form or another is the usual precursor of an acute attack. Along with this, and acting possibly as the cause, is a tendency to profuse sweating on moderate heat or exertion. Cold hands and feet are very frequently complained of—a symptom which Dr.Haig ascribes to uric acid in the blood, and which, he suggests, may be found in a more advanced condition as the local asphyxia of Raynaud's disease. During the course of the affection acute attacks occur, which are recurrent in type and usually of short duration, especially if the child is kept in bed. The pharynx is often relapsed and irritable, causing a loud, barking cough, most marked when the child goes to bed, and which may be accompanied by some bronchial inflamma


tion. The tonsils and adenoid tissue of the naso-pharynx are liable to acute attacks, which leads to chronic thickening and enlargement. Frontal headaches and symptoms of intestinal catarrh, with a furred tongue and foul breath, are com

As regards the heart a slight irregularity is occasionally found, and the pulse is often small, weak and irregular. The liver and spleen may be enlarged. In some cases abdominal pain is the only complaint, and this may sometimes be found to be localized in the right iliac fossa."

Among the symptoms connected with the excretion of uric acid, Dr. Sutherland mentions prominently renal colic, which, with Dr. Goodhart, he correctly believes to be more common in children than is generally supposed. He also calls attention to incontinence of urine and vesical irritation.

Dr. Sutherland's description of the symptomatology of this disorder is so graphic that we have thought best to repeat it in his own words. But as the description is read, one instinctively feels that the analysis has not been sufficiently close. The subject is one which as yet is surrounded by much doubt, and nearly everything which has been written upon it reflects the doubts and uncertainties of the writers. Dr. Sutherland makes no reference to age, although the cases which he reports range from 4 to 11 years.

Much of the first part of his description is very suggestive of the earlier symptoms of incipient rickets, while the latter part recalls cases of stercoremia.

Broadly speaking, the conditions he mentions are evidences of perverted metabolic processes, long continued, and in which the question of infection can hardly be supposed to enter at all.

It would seem that all possible factors in the production of perverted metabolism of this type might be comprised under the following heads :

1. Heredity-involving essential deficiency or misdirection of the elaborative, assimilative, retrograde or excretory pro


2. Deficiency of food supply in quantity or kind-producing general starvation or such special forms of starvation as rickets.

3. Auto-intoxication, produced either by poisons elaborated in the system, or by poisons absorbed from the intestinal tract.

The nutritional processes of children under two years of age are so essentially different from these processes after that age, that it would seem necessary to always take this factor into consideration.

The foregoing is offered as a preliminary plan for the study of the nutritional disorders of infancy and childhood, which are exceedingly important, but as yet very much in the dark. Jour. A. M. A.

The Bromide of Strontium in the Dyspepsias.

To say that the bromide of strontium sedates nervo-gastric irritation and controls morbid gastro-intestinal fermentation, without causing depression or any toxic symptom, is to practically state that this medicament has the highest value in all those dyspepsias which are not dependent upon purely mechanical causes. Hence its usefulness in the simple forms of dyspepsia would be regarded almost as a matter of course. This seems to have been the view taken by the eminent French observers who have lately experimented with it, for they proceeded at once to test the medicament upon the worst forms of dyspepsia-upon that class of cases which are alike the despair of the physician and the patient, and which so often lead to such final ruptures in their relations as the practitioner rarely regrets.

We here refer to those gastric phenomene which are manifested by sour and bitter regurgitations and obstinate pyrosis in all its forms; to the large class of flatulent and gastralgic dyspepsias; and those distressing distentions of the abdomen which no form of medical treatment had thus far relieved, and for which the rectal tube, electricity and massage have been able to accomplish very little. The clinical testimony of the Paris Hospital demonstrates that bromide of strontium (ParafJaval) acts like a charm in these cases, and this quality alone would give it a high position in modern therapeutics.

But not only is the bromide of strontium indicated in functional but in organic disturbances of the stomach, while in that formidable condition described as dilatation it has even effected cures.— Practitioner and News. .

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