6. LUCKE (Berl. klin. Woch., 1878, p. 248) observed a nephritis due to action of carbolic acid, which disappeared when use of drug was stopped. EDWARDS (Virchow-Hirsch’s Jahresber., 1869, i, 349), after introduction into vagina of tampons of cotton medicated with acid, saw singultus, nausea chilliness, and anasarca, with diminution or suppression of urine, delirium, and finally, death. He attributes these phenomena to an acute nephritis, with uraemia, produced by the drug. E. WAGNER (Deutsch. Arch. f. klin. Medorrhinum, 1880, p. 529) studied changes in kidneys with care. Carbolic acid was applied in a case of gangrene of leg. The next day, urine contained casts of medium width, the majority hyaline, and a few fatty, some studded with red blood-corpuscles or renal epithelium. After death, microscopic examination showed that uriniferous tubules were dilated, their epithelia large and very fatty, projecting far into their cavities, which contained numerous masses of protoplasm and jagged shining bodies. (LEWIN, op. cit.)
7. J. M., aet. 32, swallowed at 10 a.m. a bottle of carbolic disinfectant. He was seized immediately with nausea, cold sweats, stupor, and loss of consciousness. At 11:30 he was comatose, insensible to all stimuli, breathing panting and tracheal. Death appeared imminent; but at 5 p.m. he still lived, and warmth had returned. There was, however, still coma and entire reflex paralysis; conjunctiva insensible, pupils very contracted. Respirations frequent (48) and stertorous, tracheal rale, mucus from mouth. Pulse very rapid (120) and small; heart beat convulsively with some force. No urine since morning. Catheter brought away a glass of limpid non-flocculent urine, of yellow colour and violet gleam, with some oily matter floating on it and strong odour of acid. A small bleeding being practiced, blood was found black, thick, without shimmer, of peculiar brown colour by transmitted light, and smelling as urine. The clot was soft, without air, diffluent; had not contracted by next day. Died in asphyxia 2 h. later. p.m.-In mouth and throat dryness only. Oesophagus a little red and swollen, as also gastric mucous membrane, but no lesion anywhere. Kidneys very congested. Under capsule patches of sanguineous effusion. On section, haemorrhagic spots in cortical region. Under microscope walls of tubules sound, but epithelium fatty and completely degenerated, as in phosphoric poisoning. (Albumen subsequently found in urine drawn off.) Lungs, heart, and brain sound, liver congested and blackish. (RENDU, Journ de Pharm. et de Chim., 1871, p. 456.)
8. In a case of poisoning by the acid occurring in Middlesex Hospital, severe bronchitis ensued, and the patient, aet. 3 1/2, was during his recovery extremely restless, and had a vacuous, almost idiotic expression. The reporter states that bronchitis has supervened in several instances of this poisoning admitted into the hospital, and refers to fatal cases of pneumonia induced by the acid. (Lancet, October 18th, 1884.)
9. A woman, aet. 30, swallowed 4 c.c. of carbolised alcohol (=13 grammes of pure carbolic acid). Immediately vertigo, followed 10 m. later by absolute loss of consciousness with cyanosis of face. 1 1/2 h. after poison was taken there was still coma with relaxed limbs; no convulsions; pupils extremely contracted and immovable; cold sweat; respiration slow, irregular, with tracheal rale; countenance pale and cyanosed; vomiting. Pulse very quick, regular, but sometimes extinct during inspiration. The stomach was washed out, but she seemed rather worse afterwards. The urine passed 1 hour after the poisoning was normal, but that passed 15 m. later was the colour of blood. The microscope showed no red corpuscles, but the spectroscope showed the bands of oxyhaemoglobin. 1 1/2 h. after the poisoning temperature in vagina was as low as 34.4C. The tracheal rale increased, mucus was continually ejected from the mouth and nose; the tongue was retracted. She gradually recovered, but 8 h. after the poisoning the temperature was higher than normal, there were pains in throat and stomach, extreme hoarseness, bilious vomiting, urine had to be drawn off, no more haemoglobin, but some albumen, granular casts, some red globules and renal epithelium. The d. after poisoning she had circumscribed pneumonia at base of right lung. She left the hospital on the 8th d., when the vocal cords were still red and swollen, and the mucous membrane of the larynx injected; the urine still albuminous, contains granular and hyaline casts. (Rev. des Sc. Medorrhinum, Oct. 15th, 1883.)
10. A man, aet. 30, given to drink, drank off a glassful of carbolic acid in mistake for whisky. On his mouth and throat burning he gargled with water and went to a public-house. There he felt ill and did not know what happened. Half an hour after the accident he was found stretched unconscious, insensible to all excitations, skin cyanosed, limbs cold, relaxed, pupils contracted and immovable; respiration laboured and jerky; mouth exuding bloody slime; pulse small, scarcely perceptible. Chest full of large mucous rales. He was bled, sinapisms applied, and friction to the limbs. Cold compresses to chest and benzoic acid internally. After 12 hours consciousness returned. Cyanosis diminished, respiration easy, no rales. Burning pain in mouth, throat, and pit of stomach. Copious vomiting. Urine black as ink. The 3rd d. he still vomits; skin and mucous membrane of throat and mouth are still livid. The pain of the burning still severe. The 4th d. vomiting ceased; tissues less deeply coloured, now of a dull brown. Pain in chest, especially on right side; rusty expectoration. The 5th d. urine clear. Fever, bloody expectoration, violent delirium. Dullness and bronchial breathing on the right side of back below the angle of the scapula. Died on 6th d. Post-mortem. – Labial and buccal mucous membrane of a grey colour like lead. Pharyngeal mucous membrane bright red, swollen, softened, and covered with patches of exudation. Bright injection of oesophagus, which is eroded in places. Posterior wall of stomach marbled with ecchymoses, but no loss of the substance of the gastric mucous membrane. Intestines normal. Liver large and fatty. Spleen rather big. Right kidney hypertrophied and inflamed. Red hepatisation of middle and lower lobes of right lung. (Ibid.)
11. A man, aet. 37, had daily injections of a 2 per cent. solution of carbolic acid for fistulous empyema. Though the injections immediately returned, he always complained of sweetish taste on the tongue, slight giddiness, and sometimes headache that lasted several hours. Hoping to produce a quicker cure, his wife injected a double quantity of a 3 per cent. solution. Before the operation was at an end the man uttered a cry and tumbled off his chair unconscious. Stertor, agitation, groaning, violent nausea, flaccidity of the limbs except some transient convulsions in the right arm, pupils dilated and insensible; respiration irregular, laboured, noisy during inspiration; pulse not quick, very compressible, and occasionally intermittent; sensibility, almost entirely lost. At end of 2 hours he recovered consciousness, but remembered nothing of what had passed. He complained of horrible headache, nausea, soon followed by vomiting. The vision of both eyes was entirely lost. The ophthalmoscope shows very indistinct outline of the papillae, especially the right. The following m. the nausea was gone, and the patient perceived the dawn of day. Some h. later was able to see the outline of objects in his room. The 20th d. there was no longer any affection of the sight; right eye recovered itself more slowly than left. He had still heaviness of head, and he vomited when he got up. (Ibid.)
12. In a case in which a few grains of the acid in water were injected into rectum of girl of 5 1/2, for thread-worms, with unconsciousness, slight cyanosis, complete anaesthesia, and general muscular relaxation, strong trismus was present. (SCHMIDT’S Jahrb., vol. 198, p.27.).
Experiments on animals
1. There is a very considerable discrepancy between the action of the poison on animals and in human beings. In the former there occur unmistakable symptoms of irritation of the medulla oblongata and of the spinal cord, which have as yet never been witnessed in human beings. (BOEHM, op. cit.)
2. In NEUMANN’S experiments the general symptoms produced were tolerably constant in the different classes of animals; paralysis commencing in the hinder extremities and gradually spreading upwards, spasms of all the muscles, dilatation of the pupil, oppressed respiration, emaciation, diarrhoea, and death in convulsions. (Ueber die Wirkung der Carbolsaure, etc. Wien, 1870.)
3. HUSEMANN and UMMETHUN (Deutsche Klinik, 1807-1) and E. SALKOWSKY (Pflueger’s Archiv, v, 1872) have carefully investigated the general symptoms of poisoning which follow the absorption of this poison in animals.
3a. In frogs, Salkowsky observed, some time after the poisoning, consecutive to a stage of more or less paresis, clonic convulsions in the extremities, gradually increasing in severity, like those in strychnia poisoning, lasting for four hours at a time. He also verified analogous affections in rabbits, in which what at first were only general muscular tremors became general convulsions. The occurrence of these spasms in various animals is confirmed by Husemann and Ummethun. Salkowsky refers their origin to the spinal cord, as they still happen when the brain and medulla oblongata are severed from the cord, and also when the arteries conveying blood to the limbs are ligated. It could not therefore be said that the convulsions were due to asphyxia.
Hughes was a great writer and a scholar. He actively cooperated with Dr. T.F. Allen to compile his 'Encyclopedia' and rendered immeasurable aid to Dr. Dudgeon in translating Hahnemann's 'Materia Medica Pura' into English. In 1889 he was appointed an Editor of the 'British Homoeopathic Journal' and continued in that capacity until his demise. In 1876, Dr. Hughes was appointed as the Permanent Secretary of the Organization of the International Congress of Homoeopathy Physicians in Philadelphia. He also presided over the International Congress in London.