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.