If, on account of the existence of an idiosyncrasy on the part of the patient or from other causes, opium cannot be employed, we have in chloral hydrate a substitute which is almost as efficacious and perhaps even more prompt. Next to morphia, it is the most valuable remedy, and many esteem it superior to that drug, over which it possesses the advantage of not being followed by the disagreeable effects which so often succeed the administration of opiates. It should be given in doses of thirty or forty grains, and repeated if the paroxysm does not yield. The inhalation of chloroform has long been esteemed as a potent agent in overcoming the bronchial spasm. One would naturally suppose that the use of such a powerful sedative as chloroform would be a dangerous proceeding in a disease which, like asthma, is attended with so much embarrassment of respiration and circulation; but experience does not justify this fear, and Salter, who has used it with good effect in 12 out of 13 cases, assures us that he has administered it "in the very agony of the worst attacks; that, so far from fearing it under such circumstances, it has been able to relieve the intensest asthma that nothing else would reach; that he has given it, and that he has never seen any bad effects from it." He goes on to state that as chloroform relaxes the bronchial spasm, and thus removes the cause of the "asphyxial stoppage, the intensity of the apnoea, so far from being a reason against the administration of chloroform, is the great reason for its immediate employment." He considers neither muscular weakness of the heart nor valvular disease as any contraindication to its administration, provided the circulation is not materially affected. According to Stokes, the paroxysm is not entirely suppressed by chloroform, but returns as soon as the patient passes from under its influence; hence it must be repeated as occasion may require. It should always, if possible, be given at the commencement of the paroxysm, and should never be allowed to produce complete insensibility, nor should so seductive a remedy be left in the hands of the patient. The danger of the self-administration of chloroform is only too well attested by the frequent accounts in the journals of persons found dead in their beds from the effects of that agent, death in such cases being usually due to the patient's {203} unconsciously leaving the handkerchief over the mouth and continuing to inhale the chloroform after having become insensible. When given sufficiently early, a few whiffs may be all that is necessary to overcome the paroxysm; and this repeated as soon as it threatens to return, will often enable us to control the symptoms without resorting to larger quantities.