146 REPORT — 1871. 



Dr. Hills, of the Thorpe Asylum, Norwich, has, for example, favoured me 

 with the facts of an instance in which a suicidal woman took no less than 

 four hundred ami seventy-hvo grains of the hydrate dissolved in sixteen ounces 

 of water, and actually did not die for thirty-three hours. Such a fact, ably 

 observed as it was, is startling ; but it does not, I think, militate against the 

 rule that one hundred and forty grains is the maximum quantity that 

 should, under any circumstances, be administered to the human subject. 



2. A second point to which my attention has been directed is, what quan- 

 tity of hydrate of chloral can be taken with safety at given intervals for a 

 given period of time, say of twenty-four hours. To arrive at some fair con- 

 clusion on this subject, I calculated from a series of experiments the 

 time required for the development of symptoms from different doses of the 

 hydrate, the full period of the symptoms, and the time when they had entii-ely 

 passed away. Great difficulties attend this line of investigation ; but I may 

 state, as a near approximation to the truth, that an adult person who has 

 taken chloral in sufficient quantity to be influenced by it, disposes of it at the 

 rate of about seven grains per hour. In repeated doses, the hydrate of chloral 

 might therefore be given at the rate of twelve grains every two hours for 

 twenty-four hours, with less danger than would occur from giving twelve 

 times twelve (14-i) grains at once ; but I do not think that amount ought, 

 except in the extremest emergencies, to be exceeded even in divided 

 quantities. 



3. A third point to which I have paid attention is, the means to be adopted 

 in any case when, from accident or other cause, a large and fatal dose of 

 chloral hydrate has been administered. I can speak here with precision. It 

 should be remembered that this hydrate, from its great solubility, is rapidly 

 diffused through all the organism. It is in vain, consequently, to attempt its 

 removal by any extreme measures after it has fairly taken effect. In other 

 words, the animal or person under chloral, like an animal or person in a 

 fever, must go through a distinct series of stages on the way to recovery or 

 death ; and these stages will be long or short, slightly dangerous or intensely 

 dangerous, all but fatal or actually fatal, according to the conditions by which 

 the animal is suiTounded, One of the first and marked effects of the chloral is 

 reduction of the animal temperature ; and when an animal is deeply under the 

 influence of the agent, in the fourth degree of narcotism of Dr. Snow, the tem- 

 perature of its body, unless the external warmth be carefully sustained, will 

 quickly descend seven and even eight degrees below the natural standard. 

 Such reduction of temperature is itself a source of danger ; it allows conden- 

 sation of fluid on the bronchial pulmonary surface, and so induces apncea, 

 and it indicates a period when the convulsion of cold (a convulsion which 

 sharply precedes death) is at hand. 



I offer these explanations in order to indicate the first favourable condition 

 for the recovery of an animal or man from the effects of an extreme dose of 

 chloral hydi'ate. It is essential that the body of the animal be kept warm, 

 and not merely so, but that the air inspired by the animal be of high tempe- 

 rature. The first effort to recovery, in short, should consist in placing the 

 animal in a warm air. This fact is perfectly illustrated by experiment on 

 the inferior animals. In the pigeon an air of 95° Fahr. is most favourable, 

 in the rabbit an air at 105° to 110°, in the dog the same. In man the 

 air to be breathed should be raised and sustained at 90° Fahr. at least*. 



* I have no doubt it -n-ill be found, as tbo chronicle of deaths from chloral hydrate in- 

 creases, that the mortality from the agent wUl be greatest when the thermometrical 

 readings are the lowest, and vice versa. 



