160 MATER i A MEDIC A AND THERAPEUTICS. 



is threatening to fail, and in organic disease of the heart, 

 lungs, or kidneys, is but temporary, and is purchased at 

 serious cost ; for this purpose the drug is not to be recom- 

 mended. 



The action of chloral in reducing the excitability of the 

 grey matter of the cord, and higher motor ganglia, has sug- 

 gested its use in tetanus, strychnia poisoning, puerperal con- 

 vulsions, hydrophobia, sea-sickness, and whooping-cough. It 

 has also been given in some cases of chorea, but here really 

 as a hypnotic. 



The exact effect of chloral on metabolism is unknown. It 

 reduces temperature, chiefly by increased loss of heat from the 

 dilated peripheral vessels, but also by diminishing the produc- 

 tion in the weakened muscles, etc. It must not, however, be 

 given as an antipyretic in high fever, unless at the commence- 

 ment, in strong subjects, on account of its depressant action 

 011 the heart. It has been highly recommended in cholera. 



4. REMOTE LOCAL ACTION. 



Chloral is excreted by the kidneys partly unchanged, but 

 chiefly as urochloralic acid producing slight diuresis. Pro- 

 bably part escapes by the skin also, as a variety of eruptions 

 may attend its prolonged use. 



5. ADVANTAGES AND DISADVANTAGES OF CHLORAL; CAUTIONS J 

 CONTRA-INDICATIONS. 



It will be well to state here succinctly the advantages and 

 disadvantages of chloral as compared with morphia (opium). 

 Chloral has the following advantages : It acts quickly as a 

 hypnotic even more quickly than morphia subcutaneously, and 

 more certainly even when morphia has failed. After-effects, 

 such as headache, depression, and sickness are less common 

 from chloral. It does not derange the stomach, if freely 

 diluted ; nor cause constipation, even when given for a long 

 time. It may be more safely given, in proper doses, to children. 



On the other hand, chloral has these disadvantages: It does 

 not relieve pain, and is thus greatly inferior to opium in most 

 cases as a hypnotic, and useless as an anodyne. It does not, 

 like opium, prevent or relieve distress, reflex dyspnoaa, and 

 cough due to heart and lung disease. Chloral causes excite- 

 ment instead of quiet, in many cases of mania, hysteria, and 

 confirmed alcoholism. 



Chloral must 1 e given in relatively small doses to children 

 and delicate persons ; and very rarely, as we have seen, to the 

 subjects of organic disease of the heart, lungs, and kidneys, or 

 patients suffering from gout. If it excite instead of soothing 



