§ 204.] CHLORAL. 169 
without any marked change. In others, symptoms of collapse appear, 
and the patient sinks through exhaustion. 
With some persons doses which, in themselves, are insufficient to 
cause death yet have a peculiar effect on the mental faculties. A case 
of great medico-legal interest is described by the patient himself, Dr 
Manjot. 1 He took in three doses, hourly, 12 grms. of chloral hydrate. 
After the first dose the pain, for which he had recourse to chloral, 
vanished ; but Manjot, although he had all the appearance of being per¬ 
fectly conscious, yet had not the slightest knowledge of what he was 
doing or speaking. He took the other two doses, and sank into a deep 
sleep which lasted twelve hours. He then awoke and answered ques¬ 
tions with difficulty, but could not move ; he lay for the next twelve 
hours in a half slumber, and the following night slept soundly—to wake 
up recovered. 
§ 204. The treatment of acute chloral poisoning which has been most 
successful is that by strychnine injections, and the application of warmth 
to counteract the loss of temperature which is so constant a phenomenon. 
As an illustration of the treatment by strychnine, an interesting case 
recorded by Levinstein 2 may be quoted. 
A man, 35 years old, took at one dose, for the purpose of suicide, 
24 grms. of chloral hydrate. In half an hour afterwards he was found 
in a deep sleep,with flushed face, swollen veins, and a pulse 160 in the 
minute. After a further half-hour, the congestion of the head was still 
more striking ; the temperature was 39-5°; the pulse, hard and bounding, 
92 ; the breathing laboured, at times intermittent. 
Artificial respiration was at once commenced, but, in spite of this, in 
about another half-hour the face became deadly pale, the temperature 
sank to 32*9°. The pupils contracted and the pulse was scarcely to be 
felt; 3 mgrms. ('04 grain) of strychnine were now injected subcutane¬ 
ously ; this caused tetanic convulsions in the upper part of the body 
and trismus. The heart’s action again became somewhat stronger, the 
temperature rose to 33*3°, and the pupils dilated ; but soon followed, 
again, depression of the heart’s action, and the respiration could only 
be kept going by faradisation. Two mgrms (-03 grain) of strychnine 
were once more injected, and the heart’s action improved. During the 
succeeding six hours the respiration had to be assisted by faradisation. 
The temperature gradually rose to 36-5° ; ten hours after taking the 
dose the patient lay in a deep sleep, breathing spontaneously and re¬ 
acting to external stimuli, with a temperature of 38-5°. Eighteen hours 
from the commencement, the respiration again became irregular, and the 
galvanic current was anew applied. The last application aroused the 
sleeper, he took some milk and again slept; after twenty-seven hours 
he could be awakened by calling, etc., but had not full consciousness ; 
l Gaz. des H6p., 1875, 2 Vierteljahrsschr. f. ger. Med., Bd. xx., 1874. 
