Poisonings
1 a. I have myself witnessed two cases of poisoning by tart. em. One occurred in a woman to whom I was called in consultation by an experienced practitioner, under the impression that it was a case of cholera, [ Dr. B.W. Richardson states that he has been a small dose cause symptoms “strictly analogous to those of Asiatic Cholera.” (Lancet, 1856, i, 401).] though no epidemic of that disease was then prevailing. There was vomiting and purging of a whitish liquid without a tinge of bile; the pulse was extremely feeble the features shrunk, and the skin cold and of a bluish hue, especially in the hands and feet, of which the fingers and toes were of a dark livid or purplish colour; the fingers were shrunken like those of a washerwoman; there were cramps of the extremities; and the complained of extreme pain in her stomach and bowels. Upon investigating into the cause of the symptoms, we learned that she had taken, I think on the previous day, “a five- penny-bit’s worth of tart. emetic. 1b. The other instance was in an infant child, about a year old. Tart. emet. had been prescribed by the attending physician for an attack of croup, which was relieved; but directions were left with the mother to give small doses of antimonial wine at short intervals, without any warning as to the possible danger, or limitation as to the length of time. When I first saw the child some days had elapsed from the first administration of the medicine. It was in the last stage of exhaustion, pulseless, cold, pale, and purplish, and discharging whitish stools. Death quickly followed.
It will have been noticed that, in both these cases, the evacuations were whitish. They had the appearance of opaque rice- water; but differed in this respect from the stools of cholera, that they did not on standing separate into a clear liquid above, and a white flocculent precipitate. (G. B. WOOD, Therap. and Pharm., ii, 64.) 2. Two children, a boy of 5 and a girl of 3, each swallowed a powder containing 10 gr. of tart. em. mixed with a little sugar. In 20 minutes they were seized with violent vomiting and purging, and great prostration of strength, followed by convulsions and tetanic spasms; there was also great thirst. The boy died in 8, the girl in 12-13 h. P. M., 4-5 days later. In body of boy there was effusion of serum into right pleura; lower lobe of right lung posteriorly was redder than natural, and peritoneum was injected from recent inflammation. Mucous membrane of duodenum was inflamed and covered with whitish-yellow viscid secretion; this was observed throughout the intestinal canal, though colour was of deeper yellow in colon and rectum; there was no ulceration. Peritoneal coat of stomach was inflamed, mucous membrane much so, especially about larger curvature and cardiac office; no ulceration here also, but in one place a patch of lymph. Tongue was covered with white fur and seemed reddened. Dura very vascular; longitudinal sinus contained a coagulum of lymph, but every little blood; vessels of surface of brain very much injected with dark blood, whole surface having a deep purple appearance, and every portion of brain presented many bloody points on section. Cerebellum and medulla oblongata also extremely vascular; no effusion into ventricles. In body of girl, morbid appearances were similar; there were also patches resembling eruption of scarlatina on arms, legs, and neck. Arachnoid was more opaque than usual; and on mucous membrane of stomach, where inflammation was greatest, were two or three white spots, each about size of split pea, which seemed commencement of ulceration. (Lancet, 1846, left 460.) 3. Mr. -, age 35, lymphatic temperament, black hair and eyes, ruddy complexion and inclined to corpulency, addicted to high living and the excessive use of stimulants, had taken for 15 days 4 gr., upon an average, of tart. emet. in whisky, administered to him secretly by this wife “to wean him from the love of intoxicating drinks,” for which, unfortunately, he had acquired an uncontrollable appetite. Notwithstanding the drug had promptly produced its characteristic effect upon the stomach, the poor man had continued to drink until forced to take to his bed by the exhaustion caused by constant vomiting and the consequent loss of nearly all the food taken, as well as by the peculiarly debilitating effect of the drug. I was then called to attend him. He was lying on his right side, and any departure from this position was sure to be followed by an attack of vomiting. He complained of great weakness and exhaustion, was very despondent and apprehensive that he should not recover. He dreaded above all things to be left alone, even for a few moments, lest “he should be dreadfully nervous and not know what to do with himself.” His countenance was unusually pale, and wore an expression of extreme anxiety; his tongue was covered with a thick, white, pasty coating; he had some appetite for food which, however, was quickly rejected; his thirst was constant and insatiable. From the constant and long-continued use of the drug, his stomach had become intolerant of both food and drink, and he had now a great disgust for whisky, which he believed to be the cause of his illness. He declared that the very thought of it produced intense nausea. His pulse had sunk from 78, its normal rate, to 60. While taking the tart. emet. he had an attack of angina pectoris, from which he had formerly been a great sufferer, though he had for the past 4 years believed himself cured of it. Aside from this attack, which may have been accidental, neither the throat nor the thoracic viscera were affected by the use of the drug. He complained of a feeling of numbness and coldness in both legs. The right arm and hand and the great toes of both feet were cold to the touch. Cramps in the calves of the legs frequently awoke him from sleep. His breast, the anterior surface of the upper arms, the wrists, the hypogastrium, and the inner surfaces of the thighs were thickly covered with an eruption of bright red, small, conical, distinct, hard pimples, with an inflamed base, like lichen simplex. The itching from this was intolerable, irritating him at times almost to frenzy. This began to appear on the fifth day of the use of the drug, and did not appreciably abate until three days after its discontinuance. The most careful examination failed to discover any traces of pustular development. (WOODBURY, N. Engl. Medorrhinum Gaz., iv, 238.) 5. A man took 20-25 gr. of tart. em. by mistake. In a few minutes there was an insufferable feeling of heat in epigastrium, then violent pain in forehead like clavus and some giddiness; in 1/2 hour moisture in forehead and nape, vomiting for 20 or 30 m.; headache and dizziness increased, with redness of face; castor- oil caused a return of vomiting of bilious matters; burning in stomach and small intestines increased to such a degree that he became very restless, pulse weak (80), tongue white, throat, dry, taste unpleasant; inclination to sleep, which relieved him. Next day mouth was very sensitive, gums bled, with a slight spongy appearance like scurvy, lasting 2 days (DUFFIN, Ed. Medorrhinum Journ., xix, 354.) 6. A man, age 40, enjoyed good health till April preceding death. Began then to complain of frequent vomiting and burning pain after taking food, and grew thinner. In time he became so ill as to be confined to bed, and died in 10 days, with sickness, and burning pain in stomach as if hundreds of pins were prickling him; emaciation and extreme prostration; thirst; sallowness of skin, gradually increasing to well-marked jaundice; difficulty of breathing, which was very hurried at last; pain on pressure in epigastrium, but not over other parts of abdomen; gradual sinking, and death. There was no diarrhea during any part of the illness, but, on the contrary, rather a sluggish condition of the bowels. He had no cramps, and never complained of constriction of throat or dysphagia. P. M. Whole alimentary canal, from throat to rectum, more or less inflamed; liver, kidneys, and bladder congested, as well as lungs; heart and brain healthy. Antimony was found abundantly in body; and evidence showed that man’s wife had been detected in mixing tart. em. with his food and drink. (NEVINS, Liverp. Medorrhinum -Chir. Journ., i, 36.) 7. A lady suffered from extreme irritability of the stomach and sickness; the vomited matter was intensely yellow from admixture with bile. There was slight, unconnected wandering, no sleep, paleness or flushing of the countenance, swelling of the face, injection of the eyes, an aphthous state of the tongue and mouth, soreness and constriction of the throat, with pain and a burning sensation in the region of the stomach, and tenderness in the abdomen; there was a sense of loss of power and coldness from the waist to the toes, and a tingling sensation in the upper and lower limbs, with slight muscular spasms in the arms and hands. There was irritability and soreness of the rectum, and movement short of diarrhea. There was some difficulty and pain in passing urine. The pulse was generally feeble and from 120 to 132. The most prominent symptom was a constant feeling of such depression that death seemed to be close at hand. The treatment had little effect. A portion of urine on analysis was found to contain antimony, and the cause of the symptoms was revealed. No antimonial medicine had been given, and now the mental was actually in process of elimination. (TAYLOR, Guy’s Hosp. Reports, 3rd ser., iii, 373.) 8. Summary of appearances after death from antimonial poisoning. -There may be congestion of membranes of brain with softening and congestion of its substance. An inflamed or aphthous state of whole of mouth, fauces, and gullet, or this may be confined to mucous membrane of fauces and cardiac end of the gullet. The mucous membrane of the stomach is more or less reddened in patches or spots, the result of inflammation, the membrane softened or corroded and easily removed by friction, sometimes covered by false membrane or aphthous crusts; the surface darkened, inflamed or ulcerated; small ulcers with pustular exudation occasionally found; the contents of the stomach of a dark brown colour, consisting chiefly of mucous matters coloured either by blood, bile, or by a mixture of both. The peritoneal or external coat of the stomach has been found inflamed; the intestines present similar appearances, the inflamed portions of mucous membrane being seen chiefly in the duodenum, caecum, and rectum; the contents of the intestines bilious or bloody with much mucus; aphthous ulcerations of the glands of the small intestines; the lungs showing more or less congestion in portions of the lobes; the heart empty, or, if blood he contained in its cavities, this is dark coloured and liquid; the blood liquid throughout the body. In cases of chronic poisoning the liver is enlarged, softened, and its structure easily broken. The organs of the body have been found well preserved. When life is protracted there has been noticed gastro- enteritis in a severe form. (Ibid.) 9. A weakly man was attacked with bronchitis accompanied with much fever. After losing a sufficient quantity of blood he was ordered by his physician to take nitrate of potassa, but on the 3rd day from his attack he took 10 gr. of tart. em. dissolved in 7 oz. of water in 1 day. By this his chest was considerably relieved, but a severe form of angina supervened. The whole mouth and lips were very much swollen and excoriated in many places, as though from a salivation of mercury. The tongue was deep red, and dry in the middle. The soft palate and throat were likewise of a deep red, and covered with small vesicles, many of which had burst; and these parts were so much swollen and covered with thick mucus that the poor fellow was quite unable to swallow even liquids, and his breathing was obstructed. On my arrival I ordered the mouth and throat to be well rinsed with a luke-warm decoction of groats, and I observed this serious affection, which was attended with a considerable fever and nightly delirium, to give way in 3 days (TROSCHEL, Medorrhinum Zeit., Oct. 9th, 1840.) [ “After the use of tart. em. for some days, patients sometimes complain of irritation in the mouth and throat, with a metallic taste” (PEREIRA)] 10. A man, age 58, affected with pneumonia, was treated Dec. 24th-27th with tart. em., gr. iij to 3xvj of water, 2 tablespoonfuls every 3 h. On night of 27th, throat became so much affected that he could not sleep; deglutition of even small portion of liquid accomplished with utmost difficulty. At noon on 28th pulse was found 100, and tremulous; soft palate and uvula, with neighbouring parts of pharynx and root of mouth, were covered with an ash-white envelope, apparently of some thickness, very much resembling the appearances produced by a free application of nitrate of silver; portions not so covered had pale-red unhealthy colour. Next day, much thick mucus from throat and mouth. On 30th, part of “slough” came away; parts underneath red and ulcerated. Fauces, up to Jan. 7th, were still bright red, with some superficial ulcerations. At height of trouble patient felt as if head and throat were separated from trunk. (ANNAN, Medical Times, xiii, 316.) 11. The operation of tart. em. upon the gastric mucous membrane may produce a croupous process; it is, however, commonly limited to a few streaks. (ROKITANSKY, Path. Anat., Syd. Soc., ii, 26. Dr. Imbert-Gourbeyre, Gaz. Medorrhinum de Paris, 1860, cites 6 cases, besides those given here, in which pseudo-membranous inflammation of parts of the alimentary canal had occurred from the use of tart. em.) 12. In 26 out of 144 cases of pneumonia treated with large doses of tart. em., BOUDET observed its effects on mouth and throat. There was a burning sensation with constriction in pharynx and oesophagus, with swelling, dryness, heat and redness of posterior fauces, difficult deglutition, and a disagreeable metallic taste; later, upon the arches, the velum, the pharynx, the edges of the tongue, and the cheeks, ulcers made their appearance. They were generally 1 or 2 lines, but sometimes 1/2 inch, in diameter, except upon the dorsum of the tongue, where they were generally linear, and covered with a deposit resembling false membrane. (STILLE, op. cit.) 13. The false membranes produced by tart. em. in the cavity of the mouth, and principally upon the tongue, have the form of irregularly rounded patches, whitish or grayish in colour, somewhat thick, consistent, and firmly adherent. In the esophagus they are small, delicate, pale, and easily detached from the subjacent tissue. Beneath the pseudo-membrane, the lingual mucous structure is excoriated, ecchymosed, wrinkled, and forms an elevated margin around the plastic deposit, which is red and somewhat extended. The esophageal mucous membrane is ulcerated, the borders of this ulceration are not elevated, but enclosed by a grey circle, the base being softened and grayish, and, at some points, ecchymosed. (LABOULBENE, Recherches sur les affections pseudo-membraneuses, p. 132.) 14. As in the case of mercurial, plumbic, and cupreous impregnation of the system, there is likewise an antimonial sign, which is perfectly pathognomonic. It is, as with all other substances, a phenomenon of the gums and teeth. In copper impregnation, it is not so much the free margin of the gum, as the parts of the teeth next the gum, which are coated with sordes; whilst in antimonial impregnation, it is not the teeth, but the whole surface of the gums, both within and without, which assumes the appearance of the brightest pink velvet, with a raised pile. (Lancet, quoted by Marcy and Peters.) 15. Tartar emetic is a powerful local irritant. Its irritant properties may be regarded as of a peculiar or specific kind; at least if we are to judge from its well-known effects when applied to the epidermis, as in the form of solution or ointment, or sprinkled over a plaster. It causes an eruption of painful pustules, resembling those of variola or ecthyma. The smaller ones are semi-globular; the larger ones, when at their height, are flattened, are surrounded with an inflammatory border, contain a pseudo-membranous deposit and some purulent serum, and have a central dark point. When they have attained their greatest magnitude, the central brown spots become larger and darker, and, and in a few day, desiccation takes place, and the crusts are thrown off. They are usually very painful. I am acquainted with no agent which produces an eruption precisely like that caused by emetic tartar. (PEREIRA, op. cit.) 16. The clear lymph of the pustules which arise from the external application of tartrate of ant. produces inoculation pustules, which are quite indistinguishable from those produced by vaccination… I have made 31 vaccinations and revaccinations with lymph of tartar emetic pustules, and I have found them in all their relations analogous with those from cow-pox lymph. (LICHTENSTEIN, Hufeland’s Journal, xcii, 76.) 17. A girl of 14 took in the course of a fortnight [malady not mentioned] 3j of tart. em. internally. Some days after leaving off medicine, there appeared a varioloid eruption, which ran a course exactly like that produced by tart. em. ointment. (CRICHTON, Verm. Abh. einer gesell. prakt. Aerzte zu St. Petersb., 1835.) 18. A man, age 34, took for pneumonia 10 gr. of tart. em. in solution during 36 hours. In 24 hours after last dose there appeared in eruption having the most perfect likeness to that caused by tart. em. ointment. It consisted of small papule or vesicles, which rapidly enlarged and became full of pus, surrounded by a red areola, so that they resembled true variolous pustules: they were besides extremely painful. After a few day they dried up and formed crusts. Some of the pustules were larger than others, like those of ecthyma. Eruption commenced on inner surface of forearm, then spread all over back, where pustules were partly solitary, partly grouped, or even confluent. Neither vomiting nor sweat attended formation of pustules, but they were preceded by some watery stools. (BOECKER, Medorrhinum Zeit. Von dem Verbascum f. Heilk. in Preussen, 1843.) 19. An Essex farmer, suffering from pneumonia, had been taking tart. em. in 1/2 gr. doses every 3 hours for 6 d. Dr. Richardson states that he witnessed here the peculiar eruption on the skin which sometimes appears. The body was so generally covered with pustules that the friends of the patient mistook the eruption for smallpox-a natural error. (Lancet, 1856, i, 599.) 20. In 2 or 3 cases in which tart. em. had been administered, Dr. Brinton has seen a peculiar eruption of the skin, like that produced by the external application of the drug. (Ibid., p. 590.) 21. I have used tart em. in large doses in croup for the last 15 years, in children of all ages,… and have obtained a cure without any accident. I have indeed sometimes met with slight antimonial eruptions, not very numerous, on different parts of the body. (CONSTANTIN, Gaz. des Hop., Mar. 26th, 1859.) 22. I have in 3 cases seen a profuse pustular eruption on the cutaneous surface result from the internal administration of tart. em.; in 2 of the cases the eruption supervened on that of rubeola, where the complication of pneumonia had caused the medicine to be restored to in moderate doses. (BUTLER LANE, Lancet, 1846, i, 361.) 23. Dr. IMBERT-GOURBEYRE, in a paper on “Antimonial Eruptions,” shows by observations and citations that the local application of tart. em. is liable to produce pustules on other parts of the body, and especially at the ano-genital region; and maintains that these are the dynamic result of absorption, and not the effects of mere mechanical transference, on the following grounds: Ist. Several patients subjected to antimonial friction asserted that they did not touch the parts of the body which were the seat of the secondary eruptions (6 cases).
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.