One meets with numerous cases of chronic neuralgia and other pains that vaguely resemble neuralgia, and of chronic spasmodic affections, like asthma, in which the patient has got into the habit of using two, three or four ounces of chloroform every day, and sometimes even much larger quantities.

A bottle of chloroform is kept close at hand, and a teaspoonful or so (sometimes more) is poured upon a handkerchief and inhaled: this is repeated an indefinite number of times in the twenty-four hours, according to the promptings of pain or other nervous distress.

I shall not dwell upon the danger of fatal chloroform narcosis from this rough and unskilful tampering with a potent narcotic, which has resulted in several catastrophes, that both the public and the profession seem to have forgotten.

Apart from any such sudden and fatal mischief, I wish to show that the practice of constant and protracted dosing with chloroform can lead to chronic mischief, less in degree no doubt, but essentially similar in kind, to that which is produced by long-continued alcoholic excess.

Spinal irritation of the hysteric type

The worst results that I have ever seen from prolonged abuse of chloroform have been witnessed in cases of “spinal irritation” of the truly hysteric type.  That is irritation conjoined with globus, with hysteric convulsion, hysterical anaesthesia, and the occasional occurrence of sudden discharges of a large quantity of pale, limpid urine.

I can hardly speak too strongly of the mischief that I have seen caused by the reckless use of chloroform to quiet the sufferings of such patients: there is only one thing worse for them, and that is, that they should take to drink.

In the year 1865, I had a typical example of this kind of mischief from chloroform in the person of a patient of my own.

Lady, aged 41, with hysterical and spinal symptoms

She was a single lady, aged 41, the victim of complicated hysterical and spinal symptoms. There were persistent tender spinal spots, pressure on which produced very positive visceral disturbance; for instance, it was impossible to press for more than a few instants on a tender point in the upper dorsal region without provoking violent retching or actual vomiting.

Besides this there were frequently recurring attacks, which now assumed the character of hysteric convulsion, now of hysteric catalepsy, and again of spasmodic rigidity of the lower extremities. In addition to these, the patient suffered greatly from so-called neuralgic pains, chiefly in the head, but also in various parts of the body: there was also marked skin tenderness over a considerable surface on the left side of the chest, and anaesthesia, scattered in distribution and varying in amount, of the skin of the lower extremities.

To relieve the painful and convulsive symptoms chloroform had been freely, and indeed very lavishly, employed for a long period; and I had not long attended the case before I perceived that the alleviation chloroform produced was now extremely brief and slight, and suspected that the positive damage inflicted more than overweighed it. The entire sudden suspension of the chloroform, the allowance of a moderate  quantity of stimulants, and the use of Cannabis indica in half-grain doses of the extract twice a day, was followed by immediate mitigation of all the worst symptoms, and especially of a tendency, that had been rapidly growing, towards maniacal derangement.

Violent erotic excitement from chloroform use in women approaching menopause or periods

Sometimes the effect of prolonged and lavish use of chloroform on the class of subjects to whom we have just referred is even more mischievous.

It has been known to take the form, especially in women who are at or near the menopause, of violent erotic excitement, to which no doubt there was a tendency resulting from the physiological state, but which was definitely aggravated by the injudicious use of chloroform; the proof being that it diminished, or even practically ceased immediately that the drug was discontinued.

I am sure that this is a serious matter, and one that required to be carefully borne in mind, considering the great tendency of women at the grand climacteric to seek relief from their distresses by the shortest and most effective method that may happen to present itself. Drink is the worse danger, but many a woman who would shrink from brandy would take to chloroform, because it seems to be only a medicine. The same remarks apply, more or less, during the periodic times all through the sexual life of women.

Chloroform in the treatment of epilepsy

Some years ago, I was endeavouring to see if any good could be effected in epilepsy by stopping every convulsion at once by chloroform inhalation. Where one could superintend the administration oneself, or commit it to persons who were thoroughly trustworthy, the effects were at least harmless: only an exceedingly weak atmosphere of chloroform was administered, for one or two minutes; the fit was stopped, but the patient could scarcely be said to be narcotised at all. But the difficulty, in delegating the administration to nurses or friends of patients, was to prevent the unnecessary induction of positive and somewhat profound narcosis.

A girl of 19 years treated for epilepsy with chloroform

In one patient, a girl of 19 (whose attacks were undoubtedly true epilepsy, and not hysteria) required the administration of chloroform four or five times every day, as that was the frequency of the fits. Unfortunately, the person who gave it could never be satisfied without sending the patient into a somewhat profound narcosis.

At the end of sixteen or seventeen days of treatment it was evident that something was wrong, from a look of excitability and restlessness which the patient exhibited; still there was nothing positive to lay hold of till about a fortnight later.

I was sent for one evening in a great hurry, and found the girl in a state of peculiar excitement, which really deserved the name of maniacal. She had torn her clothes, struck her attendants, and abused everyone around her with much violence and gesticulation.

At first I was inclined to think that this was only an instance of furor epilepticus; but as it recurred for several days, and always as the climax to several repetitions of the chloroform-inhalation administered to stop fits, I began to suspect the possibility that the chloroform itself was to blame.

I at once completely withdrew the use of it, and all mental excitement immediately subsided.

It would not have been surprising if the fits had now recurred with severity but, during the three or four months in which I still had the patient under my care, they never exceeded, and seldom came up to, the frequency with which they used to recur before the chloroform treatment had been adopted at all.