1 
CHLORALAMID IN SURGERY. 
i 
mer, and is much superior to the latter in that it is solu- 
ble, exerts no bad influence upon digestion, possesses 
no diuretic action, never causes pruritus, vertigo, diar- 
rhoea, or other bad symptoms which sometimes follow 
the administration of sulphonal—in fact, experience is 
demonstrating the accuracy of Reichmann’s observation: 
from chloralamid no ill effects in the circulation or in 
the feelings of patients are to be noted; and, besides, 
the cost is much less than that of sulphonal. T. Lauder 
Brunton, in a recent report on the Relative Utility of 
Different Hypnotics, highly commends it,' and states 
that with reference to certainty of action and the ques- 
tion of tolerance chloralamid surpasses. 
It exerts its influence upon both the brain and spinal 
cord, producing sleep and reducing the motor excite- 
ment; it may be regarded as a pure hypnotic without 
anodyne properties, though some late reports would 
indicate that it has to some degree the power for partial 
abolition of pain. It is, then, the ideal sedative, giving 
prompt and satisfactory action, reliable results and ab- 
solute freedom from evil side or after effect, 
Its dose is from fifteen to sixty grains. The proper 
method of exhibition is to give fifteen to thirty grains 
(according to the condition of the subject), repeating 
the dose in an hour if the first have not produced sleep; 
usually from ten to thirty grains give five to eight hours’ 
refreshing slumber. The best method of giving it is to 
dissolve the required amount in about a teaspoonful of 
whiskey or brandy, or in a small glass of wine if the 
patient prefer. It may also be given in anything con- 
taining alcohol in considerable quantities, as tincture 
cardamom compound, tincture of hyoscyamus, etc. If 
for any reason it cannot be given in this manner it may 
be taken in powder form, and washed down with cold 
water or cold tea. The direction of W. Hale White, of 
London, is a good one; viz., tell the patient to dissolve 
the powder in brandy, add water to his liking, and 
drink it shortly before going to bed; this combination 
with spirits is particularly good in our surgical cases 
where whiskey is usually indicated, at least in most 
major operations. If in any case it be better to have 
the medicine in liquid form, this combination may be 
prescribed: 
R Chloralamid 5 ’j 
Spts. frumenti fl. § i 
Misce bene ut ft. solut. et adde: 
Syrupum rubi idaei fl. § i 
Misce. Sig.: Dose, one tablespoonful, to be repeated in one hour 
if sleep is not produced. This makes a decidedly pleasant mix- 
ture of slightly acid taste and fruity aroma and flavor. 
Kansas City, Mo. 
By Emory LAnphbar, M.A., M.D. 
Professor of Orthopsedic Surgery iijthe University Medical College. 
Extract from a Clinical Lecture, communicated for Notes on New Remedies 
by the author. 
Frequently after an operation of magnitude it is 
necessary to give the patient something to quiet the 
nervous system and to produce sleep. It is not always 
pain which causes restlessness and sleeplessness after 
the operation—in the majority of cases I am sure that 
the impression upon the nervous system, and particu- 
larly upon the mind, is what leads to the insomnia; for 
under our antiseptic iiietliodsyami especially where the 
wound has been covered with iodoform—a drug having 
decided anaesthetic properties—there is but a trifling 
amount of pain, often none, even after the most severe 
operative procedures. But as night draws near there is 
a growing restlessness, and at the hour when sleep 
should come the patient is anxious, nervous and wake- 
ful. What can be done? The almost universal rule 
among surgeons is to order a hypodermatic injec- 
tion of morphine; but I believe this is unjustifiable 
unless there be some indication for the anodyne effect 
of the opiate; this is markedly true in abdominal sur- 
gery; but in any case the morphine is objectionable be- 
cause it is apt to produce vomiting, is certain to seri- 
ously interfere with the process of digestion, is sure to 
induce constipation, and nearly always to give rise to 
headache, malaise, etc. Chloral has been suggested as 
a proper hypnotic; but chloral depresses the heart to a 
dangerous degree, and therefore cannot be used in these 
cases. Bromides, with hyoscyamus, will sometimes 
answer the purpose admirably, but most stomachs rebel 
against this combination, so that it is hardly safe to try 
it. What then can we use? If a drug can be found 
which will be free from all these objectionable features 
it unquestionably will fill an important place in our ma- 
teria medica. 
Such a one, it seems, has been discovered in chlor- 
alamid. This comparatively new medicinal agent is 
prepared by combination of two parts of chloral hydrate 
with one of formamide; it is found in commerce as a 
colorless, crytalline substance, nearly tasteless, soluble 
in about twenty parts of water and two of alcohol. It will 
keep indefinitely in solution without decomposition, 
but cannot be dissolved in hot solutions because of 
chemical changes. It acts very much like chloral and 
sulphonal, but does not depress the heart like the for-