“Intellectual enfeeblement and perversion of affective life and character. He became untruthful and deceitful, and manifested a dislike for home and family. Even threatened violence to his wife. Three weeks before admission he discontinued using chloral, and kept himself in a chronic state of muddle and confusion, by means of whiskey. In a day or two he became restless, excited and quite unmanageable. Diarrhœa set in, with great discharge of blood from the bowels. A state resembling delirium tremens came on. Imaginary voices mocked him; he saw loathsome animals, snakes, etc. What little sleep he had was broken by terrible dreams. This terminated in three severe and unmistakable epileptiform convulsions, at intervals of four hours. This was followed by stupor, and that by excitement.
ON ADMISSION.
“Man of average height and development, but seems to be prematurely old and broken down. Very weak and anæmic, can speak only in an undertone, and can hardly walk.
“Expression blank and vacant. Eyes dull and meaningless. Great enfeeblement of mind. Silly, childish, and almost imbecile. No excitement, but, rather, slight depression of mind. Would laugh and cry without adequate cause. No interest in surroundings. Replies to questions rambling, incoherent and disconnected, being unable to carry on a consecutive line of thought. Memory almost obliterated. Could not tell his age or where he came from. Had vague, fleeting delusions on various subjects.
“Persistent muscular tremulousness of upper and lower extremities, requiring assistance in walking, while the finer acts of coördinative power, as writing and whistling, could not be performed at all. Tongue furred in the centre, tremulous and with fibrillary twitching at the edges, and pointed markedly to the right side. Articulation thick and indistinct. Pupils equal, dilated, irregular at margins, and insensible to light. Right side of face partially paralyzed. Reflex action of cord much impaired. Common sensation acute, verging on hyperæsthesia. Complained of sleeplessness and exhaustion, but had no headache nor neuralgic pains.
“No cutaneous eruption. Muscles poor and flabby. Conjunctivæ yellow. Respiratory and circulatory system normal. Pulse 67, weak and thready. Temperature 97°. Urine, specific gravity, 1.005. Neither albumen, sugar, bile nor tube casts. Could only make water at night, when it was passed in large quantities, was clear and limpid, resembling that of hysteria. Bowels confined, fæces hard and of a white color.
“Neither narcotics nor alcoholic stimulants were used. Tonic mixture, containing strychnia, prescribed. Improvement in all the symptoms marked and rapid. Discharged, well, physically and mentally, in three months’ time.”
This case illustrates, also, the fact that the majority of those who become habituated to chloral, and in whom it works the most serious injury, are of the neurasthenic type, and manifest a morbid craving for some stimulus or narcotic.
Of the cases where I have been able to obtain information upon this point, I find the temperaments given as follows:—
| Nervous, | 63 |
| Sanguine, | 1 |
| Nervo-sanguine, | 8 |
| Melancholic, | 21 |
| 93 |