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.