Read Ebook: Drugs that enslave by Kane H H Harry Hubbell

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mbling 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. 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.

Sch?le 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 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 has, however, given it in cases of cancer of the womb, without producing bleeding. Turnbull 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.

Bleeding from the nose has been noted by Inglis , by Mauriac, in three cases and Dr. F. Delmont, of San Buena Ventura, Cal. . 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. Trembling, spasm of isolated muscles and muscular fibres, convulsions, paralysis, loss of co?rdinative power, etc., have already been spoken of.

RESPIRATION.

This vital function is very seriously affected in certain advanced cases. Dyspnoea 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 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 dyspnoea.

"This symptom was experimentally produced by the Swede, Hammersten, who observed severe dyspnoea in a cat that had taken chloral, and was briefly noticed by Jastrowitz, one of whose patients, while taking chloral, suffered from severe dyspnoea, with occasional cessation of breathing; and it was finally completely described and explained by Sch?le, 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 dyspnoea, 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 dyspnoea 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 dyspnoea, 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 dyspnoea may be anatomically explained by analogy with the effects of chloral upon the skin and mucous membrane, by hyperaemia 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-habitu?s it has been found by Fothergill to produce dyspnoea where there is cardiac disease:--

Dyspnoea 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 oedematous, the epiglottis red and swollen, and the vocal cords sometimes congested also. Cases of this kind are reported by Kirn and Chapman.

THE EYES.

Conjunctivitis from the continued use of chloral is reported by forty-one of my correspondents, oedema 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-habitu?s. Keyser, 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 anaemia. The drug was discontinued, and in a few days sight was restored.

Sch?le demonstrated that in chloral takers the retina was congested. The same condition was observed by Bouchut in the retina of children completely anaesthetized.

Burke Haywood, 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.

SYMPTOMS OF ABSTINENCE FROM CHLORAL--DOSES AND DANGERS--TREATMENT.

The symptoms incident to the abrupt withdrawal of chloral from those who have used it for a long time are rarely severe; never so severe as those attending the same procedure in opium or morphine habitu?s. Many chloral takers voluntarily intermit the use of the drug for weeks at a time, themselves.

One of the most prominent symptoms that occurs occasionally is the supervention of severe delirium, very like that of delirium tremens. Such a case is reported by Dr. Geo. F. Elliot. The patient, a man, aged thirty-five years, had, however, taken fifteen grains of opium, daily, for many years. He had for a few weeks substituted chloral, taking 200 grains of this drug daily. On withdrawing the chloral all the phenomena of delirium tremens appeared. It subsided on the use of large doses of tartar emetic and opium. Similar symptoms are reported by many of my correspondents.

Flashes of heat, nervous prostration, palpitation of the heart, dyspnoea, insomnia, sometimes persistent, intense headache with vertigo, and neuralgic pains in the occipital region, are likewise common.

After the first ten days of treatment, strenuous efforts should be made to improve the patient's health and mind by means of exercise, free diet, good reading, and pleasant conversation.

The conjunctivitis is best treated by mild astringent applications, as tea, or the following:--

?. Acid tannici, gr. vj Sodae biboratis, gr. xv Vin. opii, ? j Glycerinae, ? j Aq., ? ij. M.

SIG.--Eye wash.

The eye troubles and the skin affections usually pass away, without interference, a few days or weeks after the discontinuance of the chloral.

Restraint, full control, and a thorough search of the patient are necessary with these as with opium or morphine takers.

The practice employed by some physicians, of "tapering off" chloral eaters on small doses of opium or morphine, I consider unnecessary, and extremely dangerous, for these patients, as is well established, are prone to go from one habit to another, and the use of these drugs is placing needless temptation in their way.

PROGNOSIS.

Cure may be assured if proper control of the patient is had. As much depends on proper after treatment of these cases as in that of the morphine habit.

Relapses less often occur in these than in opium habitu?s.

Finally, then, the prolonged use of chloral is not so likely to form a habit; is not so thoroughly enslaving when formed; is less prone to endanger life in small, more prone to destroy mind and body in large doses, and is easier broken, than the opium and morphine habits.

DANGERS.

There is a certain peculiar danger attending the use of chloral that is comparatively rare among opium habitu?s, viz: that of death from an overdose; death, also, from a dose that has previously been taken with safety. Medical literature is filled with records of such cases, and instances where death almost occurred, the patient only being saved through the exertions of the physician called.

In some instances an overdose was accidentally taken; in others the person is found dead, it being probable that he took no more than his customary dose, which, however, acted with unusual strength upon a system surcharged with the drug.

Here, for instance, is, supposably, one of these cases. It is sent me by Dr. P. C. Remondino, of San Francisco, Cal.:--

A short time afterward the doctor writes: "The chloral eater died some few days ago, in Los Angelos. Was found dead in the water closet of his hotel. The despatch says, 'supposed cause apoplexy.' I think it was more likely cardiac asthenia."

Dr. R. F. Lewis, of Lumberton, N. C., writes me: "A prominent physician of this place who was intemperate in the use of spirits, morphine, etc., began the use of chloral instead, and for weeks or months was more or less under its influence. He died suddenly after using it in increased quantities the day and night before. No autopsy."

Dr. A. R. Kilpatrick, of Navasota, Texas, sends me the following curious note:--

Here is another case of death from an overdose, in an habitu?, contributed by Dr. S. Henry Dessau, of this city:--

"The only case where I have known death to be in any way connected with the administration of chloral, was in a case of dipsomania in a hysterical female. I prescribed a combination of fifteen grains of chloral with thirty grains of bromide of potassium, to be repeated every two hours, until sleep was procured; the effect was obtained after three or four doses. About eight doses were given in the mixture. I ceased attending the case, and about a year after learned through the press that the patient had died from an overdose of chloral. On inquiring from the druggist who had prepared the prescription, I learned that the patient continued to use the medicine steadily after my visits ceased, and that for twenty-four hours before death she had used two bottles of the mixture, or in other words four ounces of chloral with one ounce of bromide of potassium."

THE HASHISCH HABIT.

A common practice in some of the far Eastern countries--hashisch taking--is comparatively rare among the people of civilized nations. Here, as there, the practice is not one of steady, daily intoxication with this drug, but it, more like alcohol, is resorted to at certain times, when the system seems especially to crave it, or the temptation is offered. In this it differs materially from the practice of opium or morphia taking. In point of continual craving, we might, I think, arrange these drugs in the following order: Morphine or opium, chloral, hashisch, alcohol.

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