2. If one drop of ammonium sulphide be added to a solution of chloral hydrate and gently heated, a peculiar opalescent milky reddish-yellow precipitate forms. This test is extremely delicate, and differentiates chloral hydrate from chloroform.
3. Alcoholic solution of potash and aniline when added to chloral hydrate solution, shaken up and warmed, produces the peculiar odour of phenyl-isocyanide. This is due to the formation of chloroform on the addition of the caustic potash.
4. If β-naphthol dissolved in caustic potash solution be added to a solution of chloral hydrate and the mixture warmed, a blue colour is produced.
5. Chloral hydrate reduces Fehling‘s solution.
To separate chloroform in the stomach contents from chloral hydrate they should be acidified with tartaric acid and distilled, when the chloroform which was free in the stomach will pass over to the receiver. If the residue be now rendered alkaline with caustic potash and again distilled, any chloroform which then comes over must have been derived from chloral hydrate in the stomach contents.
Treatment.—The treatment consists in washing out the stomach, the administration of emetics, or hypodermic injection of apomorphine, in the use of galvanism, friction, mustard-plasters to the calves of the legs, artificial respiration, and the hypodermic injection of a solution of nitrate of strychnia or injection of atropine. The warmth of the body must be carefully maintained in all cases by suitable external applications. Oxygen inhalations are said to be beneficial.
SULPHONAL
Sulphonal is a product of the oxidation of mercaptol, obtained from acetone and mercaptan; it occurs in tasteless, odourless, colourless crystals or powder, was introduced into medical practice in 1888, and has since caused many accidental deaths. The habit of taking it may be acquired. It has a tendency to accumulative action when taken for some time without interruption. A serious feature in most of the cases of poisoning is that usually those taking it have been apparently benefited by the drug up to the time of the appearance of toxic symptoms.
Symptoms.—In medicinal doses (15-30 grains) it has an action similar to that of paraldehyde, it causes sleep with little depression of the circulation and respiration. Larger doses produce variable symptoms, mental confusion with nervous ataxic manifestations, stupor, and insensibility; less frequently excitement and convulsions. Skin eruptions may follow a large dose or from its long continued use. In severe cases there is marked cyanosis, feeble pulse, and stertorous and irregular breathing. Death usually results from failure of respiration, or the urine may be suppressed and fatal coma supervene. Albuminuria and hæmatoporphyrinuria are common features, especially in chronic cases. The deep pink colour of the urine was attributed to hæmatoporphyrin, and indicating extensive destruction of the red blood corpuscles. It is a grave symptom. That the colour of the urine is due to hæmatoporphyrin is questionable, for on removing the hæmatoporphyrin the colour remains the same. The cumulative action is due to slow elimination by the kidneys. A case published by Drs. Taylor and Sailer, and reported in the Lancet, February 1900, was that of a woman aged fifty-two years, unmarried, and presenting symptoms of hysteria. On inquiry it was discovered that she had been in the habit of taking sulphonal for some time, the dose being fifteen grains per diem. She was informed of the evil results likely to follow the continued use of the drug, and she discontinued its use for some weeks. After this she resumed taking the drug, and began speedily to exhibit all the symptoms of sulphonal poisoning: viz. mental confusion, marked insomnia, difficulty of speech, and a peculiar sighing dyspnœa. The urine was tinged a deep pink colour (hæmatoporphyrinuria), and a stiffness and paralysis of both legs soon developed. The control of the sphincters was lost. Cutaneous sensibility was not affected. The paralysis spread rapidly upwards, and death resulted from cardiac failure. Spectroscopic examination of both urine and blood disclosed the presence of hæmatoporphyrin. At the necropsy the following conditions were revealed: fatty degeneration was present in the heart, liver, and kidneys. The spleen was filled with a greenish pigment, both free and within the lymphoid corpuscles, the fibrous trabeculæ were greatly increased in size, and the lymphoid follicles were extremely well developed. Excessive pigmentation was found also in the lymphatic glands of the body and in the lungs. No morbid changes could be found in the spinal cord or brain.
Fatal Dose.—This is very uncertain, depending upon idiosyncrasy. Thirty grains has caused death in a woman in forty hours, while a case is reported in the Lancet, January 1904, of recovery after the taking of 365 grains. In many cases death has followed the daily use of moderate doses (10-20 grains) for several months.