Vertigo, trembling of the hands and body, and “inability to stand erect, with tendency to fall forward, as in ataxic trouble, lack of coördinating power, so as to be unable to write, whistle, button clothing, etc.” (Mattison), are often seen. The tongue, when protruded, trembles; paralysis of one side of the face and ptosis sometimes occur. Flashes of heat, followed by a cold sweat, on stumbling, “stubbing” the toe, or without any appreciable cause, is often noticeable.
CHAPTER X.
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.