Sept., 1932J CHLORAL HYDRATE DRUG HABIT : CHOPRA & SINGH CHOPRA 481 certain parts of the Punjab. This is not the outcome of the use of the drug in the treatment Original Articles of insomnia, but is due to entirely different causes. Until a few years ago in that province potable country-made spirits were allowed to CHLORAL HYDRATE AND PARALDE' be sold to retail dealers in bulk and the vendors HYDE AS DRUGS OF ADDICTION bottled the liquor themselves. Some of these ingenious people conceived the idea of diluting R. N. m.d. By CHOPRA, m.a., (Cantab.) the spirit and adding small quantities of chloral I.M.S. LIEUTENANT-COLONEL, hydrate to make up for the loss in its potency and which would result from dilution. The know- GURBAKHSH SINGH CHOPRA, m.b., b.s. ledge that the drug had hypnotic and narcotic was obtained from the (Drug Addiction Inquiry, Indian Research Fund effects undoubtedly Association) medical profession and compounders work- in It was further learnt that Series No. 15 ing dispensaries. the effects chloral hydrate in many Chloral produced by hydrate and paraldehyde belong to resemble those by alcohol, the of ways produced group drugs known as soporifics or especially when the latter is taken in large The chief use of hypnotics. this class of drugs quantities. When the two articles are taken is in the treatment of one insomnia, of the together they act in a manner synergistic to worst evils of modern times from which man- each other and in this way the effect of either kind can suffer. The physical and mental drug is largely increased. This knowledge, of are consequences sleeplessness such that the combined with the fact that chloral hydrate sufferers are driven to the use of frequent can be bought of any of the pharmaceutical hypnotic drugs, which in many cases leads to chemists at about Re. 1-12 to Rs. 2 per pound a or addiction. permanent craving without any restriction whatsoever to its sale, Louis Lewin (1931) in his well-known work has led to the abuse of the drug described in to Pkantastica has drawn attention addiction this paper. The addition of a drachm or two to this group of drugs which include chloral, added would easily make up for the removal veronal, paraldehyde, suiphonal, potassium of a substantial portion of the liquor from the bromide and bromural. Most of the cases bottle, the quantity being made up with water. referred to by him were patients who suffered Sometimes small quantities of chloral are added from were to take the insomnia who advised without any dilution of the liquor, to make the drug by a physician. Instead of giving their effects more potent in order to get a wider sale patients rational treatment, i.e., investigating among a particular class of customer. Recently, fully the causes leading to sleeplessness and the Excise Department have stopped the sale removing them, medical men often resort to the of spirit in bulk to the retail vendors and all easier course of giving powerful chemical sub- the liquor has to be sold in sealed bottles. stances with a soporific action. Again, certain This form of adulteration is, therefore, no manufacturers of medicinal drugs employ on. longer possible. Government have also prohi- their staff medical men and others who carry bited the licensees of liquor shops to keep on an extensive propaganda by advertise- chloral hydrate in the. licensed premises. ments in the medical as well as in the The to have lay press. By broadcasting literature extolling idea, however, appears lingered the wonderful sleep-producing and non-toxic and has reached the public in some of the effects of these drugs, they influence both the districts where the use of country spirits is very the medical profession and the public. In this way prevalent among population. This is dangerous substances belonging to this class, particularly the case with the central districts the are which have a powerful effect on the central of Punjab which largely populated Sikhs. to nervous system, fall into the hands of the with Owing the rise in price of the sufferers direct. country liquor, these people, who take the liquor not for the The incidence of addiction to chloral hydrate purpose of light stimulation?as is the case in western countries?but with the outside India is apparently rare, as only occa- a of intoxication sionally is a case reported. Although by object getting pronounced effects, found could not careful and searching enquiry a few cases of they get sufficient quantities of the drink with the means at their this habit may be collected, especially in modern disposal. cities in various parts of the world, there is no They, therefore, conceived the idea of them- selves quantities of chloral to evidence of any extensive prevalence amongst adding hydrate the in order to the desired effect. the masses. It is probable that on account of liquor get the its unpleasant its irritant effects on the They procured drug without difficulty and taste, small gastro-intestinal tract and its liability to produce quantities added to the potion gave them satisfaction. So the cutaneous eruptions, addiction to chloral has closely did they find effects of the mixture resembled the effects of the not spread in the same way as have the cocaine itself that chloral in these or the opium habits. Habitual use of chloral liquor hydrate parts is well known the hydrate, however, has been found to exist in among liquor-drinking 482 THE INDIAN MEDICAL GAZETTE [Sept., 1932 1 population as sukhi-sharab' or dry liquor. although apparently the source of supply was This state of affairs first came to our notice similar. This may be due to medication of several years ago when we were studying the the beverage, but we have no evidence to con- opium habit in that area. At that time, how- firm this. The excise authorities of other ever, we thought that such use of chloral provinces have not detected any specific hydrate was rare. instances of such adulteration, although in one case in Madras chloral was detected in a D. R. i.m.s., Chemical Major Thomas, examined the excise Examiner to the Punjab Government, in a specimen by laboratory. Whether the evil exists at or there letter dated the 13th September, 1931, pointed present not, is at rate of the extended use of out to this Government that a number of cases any danger chloral and other similar for adultera- of were in certain parts of drugs poisoning occurring tion of alcoholic and the Excise the These cases came in beverages Punjab. mostly of various should be bunches and were usually the outcome of drink- Departments provinces aware of it. ing bouts with liquor adulterated with chloral hydrate. Major Thomas suggested that chloral Chloral habit.?With the advent of many hydrate and butyl chloral hydrate might be new hypnotic drugs, chloral hydrate has been brought under the category of narcotic and virtually erased from the list of medicaments dangerous drugs, and their free and indiscri- in many western countries. This is due to the minate sale to the public might be prohibited. fact that not only has the drug an unpleasant We have, therefore, paid special attention to taste and produces unpleasant effects, but it this subject and have recently investigated has a marked tendency to habit formation, the various facts in connection with the use of injurious consequences of which are too well chloral hydrate, both for adulteration of known. On account of its low price chloral alcoholic beverages as well as its use as a drug hydrate is still largely used in India and its of addiction. So far as the Punjab is concerned action and uses are well known to the profes- we have found that, although adulteration of sions of medicine and pharmacy. Although liquor on a large scale has been discontinued, there is little doubt that many of the liquor the use of the drug by the liquor drinker drinkers have used chloral hydrate at one time for adulterating his own potion to enhance or other in the central districts of the Punjab, its effects is fairly common and is well the confirmed chloral hydrate addicts do not known in certain parts of the central form more than about 5 per cent, of the total districts. Our enquiries show that a number number of the liquor-drinking population. of people who habitually take liquor in large Many of them are afraid to use the drug quantities have resorted to adulterating it with because of poisoning. Outside the small area chloral hydrate. Originally the idea was to mentioned above, the Punjab appears to be at add it to the liquor to increase its effects, when present free from the abuse. on account of high price they could not afford Modes of administration.?(i) Chloral to buy sufficient quantities. Some have used hydrate is sometimes taken mixed with alco- the so that it has resulted in drug frequently holic drinks. When indulged in in this way the formation of a habit, and unless it is added it becomes absorbed into the system very to the potion satisfaction is not obtained. quickly, its action is produced in a shorter time These persons have literally become addicts. and the effects of the drug are enhanced. The Although the use of the drug is kept very ready solubility of chloral in alcohol increases secret, we found it to be fairly prevalent in its absorption into the circulation to an enor- certain parts of Ferozepore and Ludhiana mous extent.