“1. The necessity often to use a large amount, in order to obtain any effect. When awakening, thirst, nausea, headache, irritability. “2. Well-marked erythema, intensified by stimulants. Palpitation very severe. “3. Acute pains in lower limbs, especially calves of legs. Some loss and perversion of sensibility in feet and legs in morning. “4. Inability to use legs. Passed off in one day, leaving patient physically and mentally weak.” Brown-Sequard[73] relates “two cases of mania, with obstinate insomnia, in which he gave five grains twice a day to one and double that to the other, followed by thirty to forty grains at night. After seven or eight weeks of this treatment the patients had become so feeble as to be unable to walk or to put one foot before the other. This rapidly disappeared when the chloral was withdrawn.” Anstie (also quoted by Dr. Mattison), with his characteristic honesty, relates the following:— “He was called in consultation, to a lady, aged thirty-eight years, with symptoms of partial paraplegia, of obscure origin. Reflex uterine irritation was mentioned as a cause, but the suggestion was not accepted. The regular medical attendant then suggested that the nightly doses of chloral, which the patient had for some time been taking, to procure sleep and allay mental anxiety, might be a factor in the paralytic trouble. This was also rejected, and, as some sedative seemed called for, the chloral was continued. The lady, however, failed to improve from the treatment recommended, and, after one or two consultations, a different physician was called. He accepted the chloral hypothesis, the sleeping draught was discontinued, and she speedily lost her paraplegia. Anstie observed that the case afforded him some practical but rather rueful reflections.” Dr. Mattison says: “The loss of power in the lower extremities is sometimes very marked, and strongly suggestive of serious spinal lesion.” It would seem, from the rapidity with which the trouble disappears on the discontinuance of the drug, and its sudden appearance in some cases, to be due, more likely, to derangement of the circulation in the cord, dependent on vaso-motor paralysis. 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.