o Assistant-Surgeon to the London HospitaL d I Am greatly indebted to Mr. Oswald Baker, Mr. Hutchinson's Housef Surgeon, for the interest he took in this case and the care with which v he noted the temperatures. They were all taken either by him or my-t self, and sometimes by both of us. The changes were only within c certain limits, but they were so generally consistent that I cannot but % accept them as trustworthy. The fall, as soon as the patient slept, was t slight, but remained constant

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... long as she was not roused up. On f the other hand, the rise of temperature when the severe tetanic spasms occurred is equally definite. The effect on the pulse was not definite. r It would seem that in chloral we have an agent which will place a t patient suffering from the aggonies of impending suffocation owing to tetanic spasm in a position of calm sleep and muscular relaxation. That it will consequently tend to prolong life is highly probable, as I c think it did in this case. The woman certainly appeared to me very T near death's door when she was admitted, and I scarcely expected her : to live through the night. That she lived for ten days must, I think, r be attributed to the calming influence of the cnforced sleep. As to whether she would have lingered on longer, or even have recovered, if the chloral had been pushed more at the last, it is impossible to say. She had taken a large quantity of beef-tea and milk, and did not die i of wvant of nourishment, as far as one can judge. I regret that she was not seen, and her temperature noted, just before death. The nurse reported that no further spasms occurred aftcr the last dose of the chloral. Notes were taken on many other occasioiis than those specified here, but I have selected the more important. Small doses also of chloral, for the sake of experiment, were tried; but, as they produced no appreciable effect, they are omitted. A woman, forty years of age, was admitted into Mr. Hutchinson's ward, London Hospital, February 5th, 1870. She had well-marked trismus, and spasms of the muscles of the throat, so much so that she was dusky in the face and seemed in imminent danger of suffocation. She could give no history of any accident, nor could her friends. The lock-jaw set in eight days before, and for three days she had only swallowed liquids, and had not slept. Her pulse was veryfeeble and unequal. The jaws were quite shut ; but she openied them a little, to enable her to breathe better, by iniserting the handle of a spoon between the teeth and forcing them apart. She had done this for two days before admiission, anld she brought the spoon in with her. At 3.30 P. M., a dose of a drachm of chlioral, in solution, with sugar, was given by teaspoonfuls by the mouth. In half an hour the dose was repeated. A good deal was lost, and at 4 I5 half a drachm was given. Probably she had a full dose in all of two drachms of chloral. After the last dose, she became a little excited in her manner; she put the spoon on one side, as she could breathe without it; the aspect of her face became quiet; she lost the risus sardonicus; she remarked to a friend, " I am so tipsy"; and, in a quarter of an hour, was fast asleep. The muscles were fully relaxed; her mouth was open, and she was snoring loudly; the pulse became full and bounding. The temperature, before any chloral was given, was 99.6 deg.; her pulse, I04., very weak and irregular; her respirations, from 30 to 40 per minute. They were chiefly abdominal, her chest seeming rigid. When asleep, after the chloral, the temperature had fallen to normal, 98.4; her pulse was full and steady, but not altered in number of beats; her respirations were exactly those of a person during sleep, quite easy and regular. For fourteen hours she remained either asleep and snoring, or in a very drowsy condition. She would rouse up, if spoken to, or when the thermometer was put in the axilla. At 6.30 A.M., Feb. 6, a decided spasm occurred. A drachm of chloral was given by the mouth. The temperature when she was fast asleep was normal; during the night, on three different occasions, it was noted as 97.2, 97.4, and 97.8. The pulse fell to 88 and go, and the eiration to about 20. In the mornimg the ternerature was 98, the ,ulse Io and the respirations had quickened to 3. The pulse varied Lgood deaL At 6.45 A.M. (in 15 minutes) the temperature was 97.S. he was fast asleep. For the next twenty-six hours she remained either asleep, or in a lrowsy condition for the most part. Sbe would wake up now and then mnd ask for milk or beef-tea, and drink it when given to her. Once )r twice she had slight spasmodic movements, but none of any degree f severity. The temperature several times was normal, but at the end .f the time (7-30A.M., Feb. 7) was 98.9. A second full dose of a Lrachm and a-half was given by the mouth, and in a quarter of an hour she was fast asleep, and the temperature had agan fallen. Feb. 8, 10 A. hi. For twenty-six hours she lad remained in a comrortable condition, taking liquids freely, free from all but slight spasm when disturbed, and no chloral was given. At this time the tempera ture had gradually risen to gg.o, and the pulse to i 15. Half a drachm of chloral was given by the mouth. She would not take more, and it sas not insisted on. In another five hours the temperature had risen to 99.7. Half a drachm was given by the mouth, and then (as she refused the rest) half a drachm with an enema. She was then left for seventeen hours, till Feb. 9, 8 A.M., when half a drachm was given by the mouth (she refused more). She was then left for four hours. At twelve noon (fifty. two hours after the last effective dose), she had a very severe spasm. She could not put out her tongue. The temperature was higher than it had been since she was first admitted. It was OO.4. One drachm of chloral was given by the mouth, and, in a quarter of an hour, she was fast asleep, snoring, the muscles relaxed, and the temperature was normal, 98.4. At two o'clock half a drachm was given, and at 3.30 another half drachm; at five o'clock she was fast asleep and snoring. The temperature, when she was fully under the influence of the chloral, was on tlhree occasionls below normal. At io P.^i. one drachm was given by the mouth. From 12 noon, Feb. 9, to 5 P.m, Feb. Io, twenity-nine hours, she remained fairly under the influence of the chloral, and the temperature, tested a number of times, remained below normal (97 and 6, 7, or 8 tenths). She now had spasmodic movements, and she refused to take any more chloral by the mouth. The temperature had risen to 99.6. Injection beneath the skin of the arm was tried to the extent of twenty grains. Only slight effect followed. The temperature sank for a time to 98.6, and she became quiet. In three hours forty grains were injected, but in another two hours she had a severe attack of tetanic spasm, and thie temperature was again 99.6. Feb. xi, I P.Mi. Two drachms were now given by the rectum; and in fifteen minutes she began to be a little excited, the muscles relaxed, and she was soon asleep. The temperature then registered 98.0. She then slept almost continuously for twelve hours. At the end of that time (i2 noon) two drachms were given by the rectum. After this no morc was given by the mouth, as she obstinately refused to take it. Doses of a drachm and a half and two drachms were given in nine and twelve hours till IoA.MI. Feb. I2, when she appeared better than she had done at any time since her admission. She had had no further spasm; she drank fluids, seemed sensible when awake, but appeared weaker than before, and the temperature was 99.4. Two drachms in an enema were given. In twenty-one hours there was a rather severe attack of spasm ; more chloral was given, and repeated about every nine hours till Feb. 14, I p. rq., when the temperature was 99.6, but, thought she hald not hlad a large enough dose to send her to sleep, she had had enough to keep her quiet. In five hours (6 P.M.) she had a considerable spasm. She seemed much exhausted, and three ounces of brandy were given in an injection. An hour later, she was noticed to be very restless and uncomfortable, but the muscles did not seem ligid, the skin was hot, the temperature IO0.O, the pulse 150, and the respiration 45 (as a consequence of the brandy enema?). Three drachms were given by the rectum; she soon became quiet and the muscles relaxed. In four hours she was much the same, apparently asleep, not really sound and snoring, temperature 99. 5. At 8.30 A.M. Feb. 15 (eight hours later), she died. At the post nmortemit examination no important changes were detected. REMARKS.-It will be seen that in this particular case a dose of a drachm by the mouth, or two drachms by the rectum, produced certain definite efects; first of all a feeling of excitement, as if she were intoxicated, gradually passing on into muscular relaxation, and deep sleep with contracted pupils and stertor. In this condition the patient was as easily roused as if she had been asleep in a perfectly natural manner. When roused, she would take milk an beef-tea very freely and easily, even asking for it when she awoke naturally. In this respect there was a marked contrast to her condition when no chloral had been given for some time. It seenmed to me that when a stimulant (wine) was injected April 2, 1870-1 *%ft