The power of chloral to produce pains which are very likely to be called ‘neuralgic’ by the sufferer, is an important fact to remember in reference to practical diagnosis.

Without wishing to make any sensational remarks (especially as the non-medical public is apt to repeat such remarks with exaggerations), one cannot help seeing that the tendency to indulge in narcotism on slight pretexts is somewhat on the increase in society.

Formerly, if Englishmen or Englishwomen had a certain amount of pain, or worry, or sleeplessness, they endured it, and hoped for better times – an opiate being considered a serious matter by most persons. At present the list of available soothers of pain and restlessness has become much larger; and from time to time fresh substances are discovered to possess the required power, and are at first stated to be also ‘quite harmless’. This was especially the case with chloral; but that drug has proved itself a wolf in sheep’s clothing with a vengeance.

The public has not yet recovered from the belief in its harmlessness; and anyone who sees much of ‘nervous’ practice must be aware that it is an exceedingly common thing, on being summoned to nervous cases of all kinds – slight or serious – to find that chloral has become a habit with the patients for some time past: in fact, it is taking the place of the frequent ‘whiffs’ of chloroform which so many people used formerly to indulge in.

This being the case, it may well be suspected, that a good many persons who complain of pains which they call ‘neuralgic’ or ‘rheumatic,’ really owe their sufferings wholly or in part to chloral; and this forms an additional reason for that rigid accuracy of diagnosis as to the true character of pain in every case, which I have repeatedly insisted upon. And as regards the chloral-mania, it is certainly quite as necessary to give a caution as it was with regard to the abuse of hypodermic morphia.

Partial paraplegia caused by chloral

I cannot help adverting here to another consequence of the injurious action of chloral, which I learned, only a few months since, in a fashion somewhat humiliating to myself.

I was called, in consultation, to a patient who was suffering from symptoms of partial paraplegia, the origin of which it was difficult to make out. The patient was a lady of some 38 years of age, and had been passing through a great deal of agitation of mind. There was a suggestion that the paralysis was a so-called ‘reflex’ effect of uterine mischief, but this theory broke down.

The practitioner who had called me in suggested that the nightly dose (not large) of chloral, which the patient had been in the habit of taking for some time past, might be the cause; but I rejected this theory as altogether improbable, and, as there were pressing reasons, just then, for securing her some sleep, allowed the patient to continue the night-draught.

The paralysis, which I hoped was merely a temporary functional affair, due to the nervous exhaustion which she had endured, did not get any better from the remedies I recommended, and after a consultation or two another physician was called to see the case instead of me.

He approved the chloral hypothesis, discontinued the night-draught, and had the satisfaction to observe the speedy disappearance of the paraplegia! I made some practical, though naturally somewhat rueful, reflections on this little incident.

It is to be hoped that before long someone will give us a complete account of the toxicological position of chloral; for there is certainly no drug introduced of late years concerning which more erroneous rubbish has been taught. It is exceedingly useful, beyond doubt; but it is far enough from being harmless, and it would be well for us to get a complete view of the extent of its powers of mischief.