EFFECTS OF CHLORAL ON THE DIFFERENT SYSTEMS AND APPARATUSES.
THE DIGESTIVE APPARATUS.
The effect of chloral upon the organs of digestion is twofold. (_a_) That
due to its local action, and (_b_) its effects produced through the medium
of the nerves supplying the parts. Taking the throat first, we find that
there is usually more or less irritation and congestion from the local
action of the drug. In some cases there is paralysis of the muscles of
deglutition. Dr. J. H. Arton, of Hamilton, Bermuda, writes me that in one
case chloral, _no matter how given_, always produced irritation of the
throat and difficulty in swallowing. No other drugs were being given at
that time. It disappeared on stopping the chloral. This patient was not an
habitual user of the drug. It only produced this effect when the drug was
given in large quantity, or often.
Dr. R. C. Brandeis[74] relates the case of a lady who was an habitual
user of chloral. For some nine months she had been taking from forty to
sixty grains, three or four times a day. It produced great difficulty in
swallowing, intense hyperæmia of the pharynx and larynx, and the return
of fluid through the nostrils. There was occlusion of the œsophagus and
paralysis of the muscles of the larynx. She fully recovered on strychnia,
iron and quinine, finally stopping the chloral. The curious fact has been
noted by some of my correspondents, that a rectal injection of chloral
will, in some patients, immediately produce a peculiar sensation in the
throat and a metallic taste in the mouth.
“Dyspepsia” is one of the earliest symptoms complained of by these
patients. From simple loss of appetite to the gravest forms of gastric
trouble may be produced. There is loss of sensitiveness, alternating with
the most severe gastric pain. The tongue is coated, the breath foul,
and _not_ having the odor of chloroform. Circulation in the liver is
disordered, gastro-duodenal catarrh results, with accompanying jaundice,
that is sometimes intense. A sense of fullness and pain over the hepatic
region is not uncommon. Small, brownish patches upon the skin, known
to the laity as “liver spots,” are frequently seen. The bowels are
constipated, the stools lacking in bile, and, consequently, clay-colored,
hard, and sometimes coated with mucus, here and there streaked with
blood. Hemorrhage from the bowels and stomach sometimes occurs. Diarrhœa
alternates with constipation.
Some patients, taking the drug in large amounts and for a considerable
time, are not troubled at all with affections of the digestive organs.
An habituè, a physician in the South, assured me that it always increased
his appetite when taken before meals, and Dr. A. P. Hayne, of San
Francisco, says that he has seen a number of these cases, in which there
was no effect on these organs beyond a temporary stimulation.
THE URINARY ORGANS.
Upon the kidneys the effect of the long continued use of chloral is to
produce congestion, dilatation of the vessels, and albuminuria. There is
no positive evidence that chloral produces any organic change in these
organs. Albumen is present in the urine, often in large amount, but its
presence there is readily accounted for by the vaso-motor paralysis, and
the impoverished condition of the blood, which is still further aggravated
by this, its symptom. Casts are often found, but are usually small and
medium sized light granular, and hyaline. Epithelial and fatty casts
occasionally occur, but it is probable that, in these cases, renal disease
had commenced before the chloral was used to excess. Hemorrhage from the
kidneys and, indeed, from the whole urinary tract, is sometimes found.
It is but a part of a general condition, usually, purpuric spots being
found on the skin, and bleeding occurring from the mucous membrane of the
throat, stomach, nose, or bowels.
Both before the albuminuria appears, and during its continuance, dropsy is
not uncommon. Puffiness of the face and eyelids, dropsy of the feet and
legs, and ascites occur in certain cases, not from suppression of urine,
but from the condition of the vascular system and blood.
The albuminuria, unlike that of opium patients, is usually persistent.
Diabetes is found in some cases where large amounts of the drug have been
used for a long time. In acute poisoning by this drug sugar has been
found in the urine of man, by Bouchut[75] and Levenstein[76]. Labbée[77]
failed to find it in the urine of chloralized rabbits and frogs, but
Feltz and Ritter[78] found it in the urine of dogs into whose veins they
had injected chloral. They proved its presence by both the fermentation
and reduction tests. They also claim to have found an organic body,
which was present in such small quantity that a determinative analysis
was impossible. The same substance was probably found by Von Mering and
Musculus, who named it _uro-chloralic acid_. They found that it reduced
the copper and bismuth tests, and turned the polarization apparatus to the
_left_. This from small doses, while large doses gave sugar, turning the
polarization apparatus to the _right_.
Dr. John B. Roberts and Morris J. Lewis[79] found that the urine of
patients taking chloral, and urine to which chloral had been added, gave a
yellow precipitate, with Fehling’s test solution.
It is probable that in the urine of patients habitually using small doses
of chloral, the reaction with the copper solution is due to the presence
of uro-chloralic acid, while that of those taking large doses is due to
both uro-chloralic acid and sugar; the preponderance of the latter masking
or overcoming the reaction of the former, especially with the polarization
test.
The functional activity of the kidneys varies greatly from day to day.
At times the urine is very scanty and high colored, at others, passed in
quantity and of a light straw color. Unlike the urine of opium takers, the
gravity varies markedly from day to day (1.006 to 1.045).
On the mucous surface of the bladder and urethra the continued use of this
drug sometimes produces decided irritation, and often congestion. Frequent
desire to urinate, burning and cutting pain in the act, and a sensation
as if the contents of the bladder had not been fully evacuated, are often
found, more especially in women.
It has an action, also, on the muscular structure of the viscus, producing
temporary paralysis, with retention.
Oxalate of lime, and numerous fibrillæ of mucus, occur as deposits. The
reaction varies from intensely acid to distinctly alkaline.
Deposits of stellar phosphates are of frequent occurrence.
My correspondents report as follows:—
Irritability of the bladder, with tenesmus, 21 instances.
Hemorrhage from the urinary organs, 6 ”
Retention of urine, 11 ”
“Atony” and paralysis, 7 ”
Albuminuria, 23 ”
Reduction of copper test, 16 ”
Casts in urine, 7 ”
SEXUAL ORGANS.
The evidence as to the effect of the continued use of chloral on the
sexual apparatus is meagre and conflicting. The sexual appetite seems
to be at first decidedly increased, but finally greatly impaired or
lost. Such an increase was observed in one case by Dr. J. A. Miller, of
Williamsburg, Ky. (non-habituè). I have seen a decided increase in two
cases from occasional small doses, where the effect could have been due to
nothing but the chloral; and in one case, by Dr. John N. Upshur,[80] where
it had been used for weeks, with large doses of the bromides, in a case of
tetanus in a negro.
On the other hand, Dr. Edward Bradley, of this city, writes me that in
ten cases he has found decided decrease in sexual appetite and inability
to have an erection in patients taking chloral for a short time. It
disappeared shortly after stopping the chloral. Dr. J. W. F. Webb,[81]
of Liberty, Miss., has known it to diminish and temporarily destroy the
sexual appetite, when taken only for a few days. Also in the case of a
chloral eater.
Dr. Horatio C. Bigelow,[81] of Washington, D. C., saw “loss of erectile
power follow the use for one month of ten grains of the drug, three times
daily.” The person was a strong, healthy man, seemingly of good virile
power, to whom it had been given for chronic dysentery. He was never so
affected before. It was some months before there was any return of power.
Dr. J. H. Nordlin,[82] of Rome, Ga., has used it successfully as an
anaphrodisiac, as also a correspondent of the _Lancet_.[83] Dr. O. F. Ham,
of North Barnstead, N. H., writes me of a chloral taker, a lady, whom he
has questioned closely. She avers that chloral has absolutely no effect on
her sexual appetite, which was never marked.
Sensitiveness of the organs of generation, a kind of mucous membrane
hyperæsthesia, has also been noted by Dr. H. H. Doane,[82] of Litchfield,
Ohio, as follows:—
“Female, aged forty-two; used chloral for twelve years. Given for
insomnia and nervousness of prolapsus uteri, with constipation. Bilious
temperament. Dose, twenty grains, four or five times a day. Present
condition, prolapsus uteri, obstinate constipation, great loss of flesh
and muscular power, appetite poor, stomach weak and tender on pressure;
also constant, dull, and sometimes sharp gastric pain. Headache, nervous
prostration, loss of mind (general melancholia, with suicidal tendency, if
chloral is withdrawn for a few days). No pain in neighborhood of joints,
slight dimness of vision accompanying headache. No family history of
morphine or opium habit or alcoholism. Extreme sensitiveness of sexual
organs.”
Its effect on menstruation is slight. It sometimes causes too free flow,
sometimes a slight, continuous flow. I can find no facts supporting
the belief that it, like morphine or opium, produces sterility. As
menstruation seems to be unaffected it is probable that it does not do so.
As bearing upon the effect of chloral on menstruation, the following
letter is of interest. No replies seem to have been received.
_To the Editor of the Lancet_:—
SIR—Have any of your correspondents noticed one peculiarity in
the action of hydrate of chloral—namely, its power entirely to
check the catamenial discharge? I have three patients who are
in the habit of taking the drug, for attacks of asthma, and who
have assured me that its exhibition is attended with this one
drawback, if taken at the onset of the monthly period. I have
had no opportunity of verifying their statements, but imagine
there must be some truth in them, as they are all three of them
in different stations of life, do not know one another, and
cannot have compared notes. Moreover, their statements were
volunteered, and not elicited by leading questions.
Your obedient servant,
G. H. R. DABBS, M.D.
_Newport, I. W., Sept. 21st, 1872._
CIRCULATION AND COMPOSITION OF THE BLOOD.
Aberrations in circulation are due to derangement of the nerves governing
the vessels; in other words, the vaso-motor system.
Flushing of the face, fullness of the head, redness of the ears,
congestion of the eyes, alternating hyperæmia and anæmia of the various
organs, is the result. From this cause we have the intense splitting
headache one day, vertigo the next.
Palpitation of the heart, a weak, intermittent, irregular pulse, cough due
to lung hyperæmia, accompanied by excess of secretion, often follow. Heart
murmurs are sometimes heard, chiefly in very anæmic patients. Palpitation
and irregular action of the heart is due to three causes, in the majority
of cases—irregular nerve supply, impoverished blood, and atony of the
cardiac muscles. This is not so in all cases, for we sometimes get these
same symptoms from single doses of chloral, referable wholly then, I
think, to disturbed nerve supply.
Upon the blood itself chloral acts as a disorganizer. That it does so
we know. How it does so it is impossible to tell. This deterioration is
evidenced by its action on the skin, to be noticed fully further on; by
the tendency to hemorrhage from mucous membranes, purpuric spots beneath
the skin, spongy gums, falling of the hair, loss of the finger and
toe-nails, malnutrition of the muscles, brain, and nervous system, anæmia,
dropsy, and the but too palpable evidences of a general breaking up of the
whole system.
Ludwig Kirn,[84] who has contributed some very valuable observations on
the long continued use of chloral, relates the following:—
“We come now to a fourth group of cases, in which both the quality of the
symptoms and their greater or less extension in the organism indicate a
distinct change in the composition of the blood.
“In this connection, the following cases, observed by Crichton Browne,
may first be referred to; their interesting phenomena justify a detailed
report.
“CASE 1.—A woman, aged sixty-nine years, suffering from periodical mania,
had twenty grains of chloral twice daily; on the fourth day a redness was
developed on the skin of the chest and shoulders, which did not vanish on
pressure; on the sixth day the eruption had extended over the whole trunk
and limbs, livid spots and deep-red patches alternating. The lips and
the mucous membrane of the mouth were excoriated, the gums spongy, the
tongue blistered and ulcerated, the breath fœtid. The general state was
one of great depression; pulse 120. On the eleventh day the ulceration of
the mouth had extended further; the lips were covered with crusts. The
petechial eruption was diminished on the chest and abdomen; the spots were
yellowish, with patches of white skin between them; the spots on the arm
lost their redness later. On the fifteenth day there was a sort of general
desquamation; fissures of the skin over the sacrum and in the neighborhood
of the joints. From that time convalescence proceeded and ordinary health
was restored.
“CASE 2.—A woman, aged forty-six years, suffering from cardiac disease,
hemiplegia, and dementia, took fifteen grains of chloral, three times a
day, with calming effect. On the nineteenth day of the treatment numerous
purple-red spots appeared in the neighborhood of the left elbow; on the
next day many similar spots were seen on the shoulders and forearms, which
coalesced with the others. On the twenty-first day livid spots came on
the face; the left arm swelled and became hard. On its surface appeared a
multitude of minute points, of a much deeper color, which did not diminish
on pressure. Next day there were dark purple spots and discolorations;
some small, round, and circumscribed; others broad and irregularly shaped,
on the legs and abdomen, and in stripes on either side of the vertebral
column. Simultaneously with the petechia there was great prostration,
tendency to somnolence, weakness and excitability of the pulse, sore lips,
thickly coated tongue. On the twenty-third day the spots and discolored
patches had extended in every direction, and the previously bright-red
spots had assumed a deep-purple color. Finally, signs of lung congestion
appeared, with gradual failure of power, and death, after several fainting
fits, on the twenty-sixth day. At the autopsy numerous ecchymoses, of
every shape and size, were observed, more or less, on all parts of the
skin; the right lung was congested and œdematous; the heart dilated and
its valves thickened; over the right central hemisphere there was a large
arachnoid cyst, containing fluid blood.
“With the foregoing may be joined a case, related by Monkton, in which,
after four days’ administration of sixty grains of chloral daily, a rash
resembling slight variola, with hemorrhagic purpura, appeared, and death
occurred on the sixth day, by syncope.
“Finally, may be mentioned two patients of Pelman, in whom, after
treatment with chloral, there were larger and smaller petechia over the
whole skin; in one which proved fatal numerous petechia were found on the
mucous membrane of the larynx and under the endocardium, and a hæmatoma on
the right side in the skull, reaching to the base, the fluid contents of
which gave evidence of their recent origin.
“I shall now relate a case observed by myself, which is yet more striking,
from the multiplicity of its phenomena, which are of a kind, perhaps, to
give us some clearer understanding of their origin. The case was observed
by me at a time when the evil effects of chloral hydrate were not yet
known; the medicine was, therefore, continued, in spite of the most
multiplied symptoms, because chloral was not for a long time recognized
as their cause; the affection was, therefore, followed up further than we
should dare to do now, that our increased knowledge would oblige us to
stop at an earlier stage. [Here follows a detailed report of the case,
which need not be given]. If we may sum up the weightier symptoms of
this case, we find a young, strong, personally healthy person suffering
from uncomplicated mania, in whom, on the ninth day of chloral treatment,
a rash appeared in the form of groups of red spots, which soon became
confluent. On the twentieth day the temperature and pulse rapidly rose
to a febrile pitch; three days later the temperature had reached 106.7°;
large and repeated doses of quinine were given without result, and baths
had only a temporary effect. Œdematous swelling of the face, cheeks,
eyelids and ears now set in. During the whole course of the disease the
skin, so far from returning to its natural appearance, was the seat, now
of impetiginous, now of moist, now of scaly eczema and ichthyoses, so
that the process of desquamation, instead of being short, as in the acute
exanthemata, occupied many weeks, during which great sheaths of epidermis
were cast off from all parts of the body.
“The profound lesions of the skin nutrition were evidenced in the later
stages by a remarkable shedding of the hair, and a gradual falling off
of all the nails of the hands and feet. The affection of the skin was
accompanied by a similar one of the mucous membranes, first of the
intestines, which kept up watery diarrhœa in spite of medicine, and then
by a similar affection of the conjunctiva and the bronchi. From the
sixth week of the disease onward a series of large abscesses formed on
both arms, over the shoulders and armpits, which secreted a considerable
quantity of pus. While these phenomena were occurring there had been for
eight weeks a continuous fever, occasionally remitting, and then again
running up to a temperature beyond 104°.
“The symptoms which we have now collectively described must be defined as
chronic blood poisoning. We cannot, however, place this in any of the
known groups; we have not to do with a pyæmia or septicæmia, nor with
a metallic or vegetable poisoning, since none of the causes have been
at work which would lead to these affections, nor do we observe their
characteristic phenomena; still less did the affection which the medicine
produced in this patient resemble puerperal mania. In fact, there was
no other external cause except the administration of the chloral; this
medicine, which in even much larger single dose produces no such effect,
was for ten weeks given in nightly doses of forty to sixty or even
seventy-five grains; sometimes in two doses daily. The symptoms began
after a certain saturation had been produced by accumulation, to spread
further and further, and finally to assume the complete picture of a
chronic blood poisoning.
“The origin of the disease leads us thus, by exclusion, to conclusions
which have a high degree of probability, and we are also in a position to
adduce positive facts. If a glance be cast at the symptoms observed by
ourselves and others, after a more or less continued administration of
chloral, we meet with the greater part of the phenomena observed in our
last case, especially the very various affections of the skin and mucous
membranes, the alterations in vascular action, and finally, the profound
alterations of the blood, which in some cases remind us of the phenomena
of scurvy.”
The characteristic feature in the morbid picture which we have given
consists less in symptoms which in themselves are altogether new, than in
the assemblage of the most heterogenous phenomena, which previously had
only been observed singly, in one person, and in a most aggravated degree
of intensity.
It is a peculiar fact, that such severe symptoms as are here related,
comparatively common in the early history of the drug, are not now seen,
save in very rare instances, even in persons using larger quantities of
the drug for a much longer time. There must have been some impurity in the
drug as then used. It might be supposed, also, that such effects would
be more apt to occur in these insane patients, much below par mentally
and physically, was it not well established that its prolonged use in
like cases, at the present day, does not produce the same effects, save
in occasional instances.[85] The ulceration of the skin about the finger
and toe-nails, spoken of by so many observers. Thus, Professor Nathan R.
Smith, of Baltimore,[86] reports two cases where this occurred. Twenty-six
similar cases have been observed by Dr. James G. Kiernan,[86] former
Assistant Physician at the New York City Asylum for the Insane.
From eighteen superintendents of insane and five physicians of inebriate
asylums, from whom I have heard, not one mentions this condition of skin
about the edges of the nails. The only case of the kind reported to me is
by Dr. J. W. F. Webb, of Liberty, Miss., and consisted in simple elevation
of the skin at these points, without ulceration.
I think we must conclude that there was some impurity of the drug used,
although Dr. Kiernan avers that the drug was that furnished by Powers &
Weightman.
Disordered condition of the blood manifests itself in other skin
affections. Judging from its effects in single or small doses in certain
persons who manifest an idiosyncrasy, would lead us to entertain the
possibility of skin affections from the long continued use of the drug. An
artificial idiosyncrasy seems to be developed.
Single doses, or the use of moderate doses for a short time, has been
found to produce erythema, eczema, papular, pustular, or macular
eruptions; also urticaria and herpes zoster. In a few well-authenticated
instances, eruptions, exactly resembling and in some cases mistaken
for those of measles and scarlatina, have been produced. They passed
through regular gradations, finishing with the typical desquamation of
the disease simulated. Further use of the chloral again produced the
same disturbances.[87] It has been suggested that these effects are due
to disorders of the digestion, as excessive acidity, etc., produced by
chloral. This is disproved by the fact that in the majority of instances
where they occur, the digestive organs are not disturbed.
Schüle[88] believes that the majority of these skin affections are due to
nervous disturbance.
The following cases of hemorrhage are of interest in this connection:—
Dr. A. E. M’Rae (Edinburgh _Medical Journal_, Nov., 1871) relates a case
of hysteria, where he gave chloral for months. Bleeding from the lungs
became so frequent and violent that twice the patient’s life was despaired
of, and he had to abandon the use of the drug entirely. He refers also to
a case by Dr. Husband, where fatal hemorrhage from a fibrous tumor of the
womb occurred in a patient who was taking chloral. Spencer Wells (_Medical
Times and Gazette_, Sept. 18, 1869) has, however, given it in cases of
cancer of the womb, without producing bleeding. Turnbull (Philadelphia
_Medical and Surgical Reporter_, Aug. 31st, 1872) claims that it increases
the menstrual flow. Dr. C. R. Cullen, of Richmond, Va., writes me that he
has seen flooding follow its use. R. C. Shettle, Physician to the Royal
Berkshire Hospital, believes that its use is dangerous in labor cases,
owing to the likelihood of flooding afterwards. This is totally disproved
by a mass of testimony sent me by my correspondents.[89]
Bleeding from the nose has been noted by Inglis (Edinburgh _Medical
Journal_, Sept., 1877), by Mauriac, in three cases (_Gazette des
Hopitaux_, 1870, p. 405) and Dr. F. Delmont, of San Buena Ventura, Cal.
(by letter). This was a hysterical lady, who was using large quantities of
chloral. After one of her spasms about an ounce of blood flowed from her
mouth in a fine stream, as though thrown by a syringe.
MUSCULAR SYSTEM.
Upon this system the effects are decided, and are chiefly produced through
the agency of the nervous system.[90] Trembling, spasm of isolated muscles
and muscular fibres, convulsions, paralysis, loss of coördinative power,
etc., have already been spoken of.
Certain symptoms, as flabbiness, paleness, atrophy and weakness, result
from imperfect nutrition. By confining these patients to the house a
great deal it still further lowers the tone of the general health.
RESPIRATION.
This vital function is very seriously affected in certain advanced cases.
Dyspnœa is the most prominent symptom. This is more marked if alcoholic
stimulants are taken. The trouble is undoubtedly of purely nervous origin.
It is usually accompanied by a slight cough, and excessive secretion of
mucus. Ludwig Kirn[91] says:—
“An important symptom which we have noticed in a series of cases of the
long continued use of chloral is an interference with respiration, which
may remain slight and scarcely troublesome to the patient, or may become
positive dyspnœa.
“This symptom was experimentally produced by the Swede, Hammersten, who
observed severe dyspnœa in a cat that had taken chloral, and was briefly
noticed by Jastrowitz, one of whose patients, while taking chloral,
suffered from severe dyspnœa, with occasional cessation of breathing; and
it was finally completely described and explained by Schüle, who observed
a patient who, after a long use of chloral, used regularly to suffer after
meals from a sense of oppression, which made going up stairs extremely
difficult, and even interfered with speech, although there was no chest
disease to account for this. The symptoms persistently recurred in spite
of all treatment, until the chloral was left off, when the oppression
entirely disappeared. A similar chloral dyspnœa, though not so long
continued, occurred in many cases observed by us, either with or without
a rash, and a feeling of heaviness and anxiety. That the chloral dyspnœa
does not always stop at the lower degrees, but may proceed to the most
severe and dangerous developments, is shown by the following observation
communicated to me by an eminent physician. This gentleman was summoned
in consultation by a lady prostrated by long suffering, who had of late
suffered from attacks of extreme dyspnœa, which had increased to asphyxia.
At the same time the face was swollen, the facial muscles paralyzed, and
there were also all the signs of cerebral effusion.
“Every remedy had failed, and the patient seemed on the brink of the
grave. The physician, therefore, recommended the discontinuance of a
daily dose of forty-five grains of chloral which had been given as an
hypnotic, whereupon all these highly alarming symptoms vanished, in an
almost magical way; the cerebral disturbance ceased, and the respiration
quickly resumed its normal type. The dyspnœa may be anatomically explained
by analogy with the effects of chloral upon the skin and mucous membrane,
by hyperæmia of the lungs, which is produced through the channel of the
vaso-motor nerves.
“We find here a further confirmation of the assumption that chloral
operates upon the vaso-motor centre and the medulla oblongata, and that
its paralyzing influence extends thence to the peripheral branches of the
affected nerves. This might also lead to a practical contra-indication of
chloral in all morbid conditions where there is a tendency to congestions
or stases of blood in the lungs.”
In non-habituès it has been found by Fothergill[92] to produce dyspnœa
where there is cardiac disease:—
“A patient was taken into the West London Hospital, with emphysema and
aortic stenosis. In spite of rest, digitalis and ammonia, he was liable
to attacks of dyspnœa, which had come on _since_ his admission into
the hospital. On searching for an explanation, it was found that the
house-surgeon had benevolently prescribed chloral for the sleeplessness
complained of. This was at once stopped, and the attacks of dyspnœa never
returned, though the man gradually sank.”
Dyspnœa is reported by thirteen of my correspondents as a symptom of the
continued use of chloral.
On the throat and larynx the effect is one of decided irritation,
attended by congestion and sometimes ulceration. The uvula is congested
and œdematous, the epiglottis red and swollen, and the vocal cords
sometimes congested also. Cases of this kind are reported by Kirn[93] and
Chapman[94].
THE EYES.
Upon the eyes the continued use of chloral produces a very decided and
characteristic effect. Some persons not addicted to the use of chloral
manifest a peculiar idiosyncrasy with reference to it. A single dose
sometimes, more often a few doses, will produce severe conjunctivitis,
occasionally accompanied by œdema of the subjacent parts, as also of the
face. Photophobia is often marked. Abundant testimony as to this effect of
chloral on the eyes may be found in my article upon that subject in the N.
Y. _Medical Record_ for 1881.
Conjunctivitis from the continued use of chloral is reported by forty-one
of my correspondents, œdema by thirteen, and photophobia by thirteen.
Sixteen report “weakness of vision,” nine report “double sight,” one
cataract, one sudden blindness disappearing on discontinuance of the drug,
one ptosis, four amblyopia, and six asthenopia. Two cases of temporary
blindness from chloral are also reported. This was in non-habituès.
Keyser,[95] of Philadelphia, reported the case of a gentleman accustomed
to sixty and eighty grain doses of chloral, who suddenly became blind.
Opthalmoscopic examination revealed great retinal anæmia. The drug was
discontinued, and in a few days sight was restored.
Schüle[96] demonstrated that in chloral takers the retina was congested.
The same condition was observed by Bouchut[97] in the retina of children
completely anæsthetized.
Burke Haywood,[98] of North Carolina, observed an elderly man, who, after
some weeks’ use of chloral, began to complain of dimmed vision, which
persisted and increased till the drug was withdrawn, when it gradually
disappeared.
The case of ptosis is reported by Dr. H. C. Bigelow, of Washington, D. C.,
as follows:—
“Female, aged thirty years, married, spare build, nervous temperament,
and active mind. Grains thirty to sixty, daily, for eighteen months.
Emaciated, hysterical, constipated, flatulent. Temper irritable. Ptosis of
the right eye, commencing iritis and photophobia. Ulceration of os uteri.
Had an orgasm while being examined. Vaginismus; sexual appetite strong,
but dislikes her husband and marital intercourse. Suffers from insomnia,
loss of memory, mental unsteadiness. She ascribes all these symptoms to
chloral.”
Dr. N. C. Husted, of Tarrytown, N. Y., reports to me the case of a lady
who has used the drug in from ten to twenty-grain doses, for about
eighteen months. She is troubled with partial amaurosis and excessive
lachrymation.
Dr. Edward Bradley, of this city, reports to me the case of a lady who
took twenty grains of chloral, three times a day, for some time. Eyesight
gradually failed, and she was soon obliged to wear glasses. Her eyes were
thoroughly examined, and nothing abnormal was found. On discontinuing the
chloral the eye trouble speedily disappeared. The effects of the drug on
the general system, especially the digestive apparatus, was very marked.
The habit was broken without trouble.
For a full discussion of the subject here presented in outline, the reader
is referred to my article in the _Record_, already spoken of.