Bleeding from the nose has been noted by Inglis (Edinburgh _Medical Journal_, Sept., 1877), by Mauriac, in three cases (_Gazette des Hopitaux_, 1870, p. 405) and Dr. F. Delmont, of San Buena Ventura, Cal. (by letter). 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.[90] Trembling, spasm of isolated muscles and muscular fibres, convulsions, paralysis, loss of coördinative power, etc., have already been spoken of. Certain symptoms, as flabbiness, paleness, atrophy and weakness, result from imperfect nutrition. By confining these patients to the house a great deal it still further lowers the tone of the general health. RESPIRATION. This vital function is very seriously affected in certain advanced cases. Dyspnœa 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[91] 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 dyspnœa. “This symptom was experimentally produced by the Swede, Hammersten, who observed severe dyspnœa in a cat that had taken chloral, and was briefly noticed by Jastrowitz, one of whose patients, while taking chloral, suffered from severe dyspnœa, with occasional cessation of breathing; and it was finally completely described and explained by Schüle, 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 dyspnœa, 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 dyspnœa 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 dyspnœa, 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.