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330 DENTAL MEDICINE.

which is followed by sudden and complete sleep, very much like
natural sleep, calm, dreamless and refreshing. It differs from a
condition of narcotism from the fact that the patient can be
easily roused to partake of nourishment, and will readily fall
asleep again.
There are no unpleasant after-effects resulting from a mod-
erate dose of chloral, differing in this respect from morphine,
which often causes headache, faintness, giddiness, nausea and
constipation. Chloral is not capable of producing insensibility
to pain, unless the quantity administered is sufficient to suspend
the functions of the cerebrum. Great care is necessary in its
use where symptoms of pulmonary disease, fatty-heart or
degenerated blood vessels are apparent.
When a proper dose is administered the pupil contracts
slightly, but the pulse may remain unaltered or become slower,
and the respiration unaffected. When an improper or dangerous
dose is taken, profound narcotism ensues, the respiration becomes
slower, the pulse weak, rapid and irregular, sensibility is lost, all
reflex movements are impossible, and complete muscular relaxa-
tion follows. It destroys life by the suspension of the functions
of the cerebrum, and by paralysis of the respiratory centre, and
of the cardiac ganglia ; also death may suddenly follow by paral-
ysis of the heart, in cases of fatty degeneration, and the lower
lobes of the brain remain unaffected. The paralytic phenomena
caused by chloral are due to its direct action on the nervous
centres. The congestion of the meninges of the brain and cord,
and distension of the right cavities of the heart, have been observed
after poisoning by chloral. The antidote in cases of poisoning
is strychnia, and the same treatment as in opium poisoning.
Therapeutic Uses.—The most important uses of chloral are in
diseases of the nervous system, such as delirium tremens, insan-
ity, tetanus, acute mania, neuralgia, chorea, whooping-cough, and
in rheumatism, cholera morbus, seasickness, etc., etc. Having
no direct pain-relieving power, except by suspending the func-
tions of the cerebrum and in dangerous doses, sleep can be pro-
cured and pain relieved by combining the chloral with morphine,
when it is very effective.