Cannabis indica.
[* For these corrections we are indebted to Dr. Berridge’s paper in Hom. Phys. for Jan., 1887. As regards the omissions he notes, we venture to think that we have given an amply sufficient series of observations for illustrating the action of the drug.*] – P. 715, l. 22, for “feet” read “foot.” L. 4 from bottom, after “this” add “condition of heart.”
P.716, l, 32. For this sentence substitute “Remembered events that had happened, ideas that had passed through his mind when a child, as about toys.” L. 44, after “short” insert a comma. L. 46, for “1 p.m.” read “1 a.m..”
P. 717, l. 20, for “talked nonsense and” read “knew he was talking nonsense, but.”
VOL. II
Carboneum sulphuratum.- (Additional poisonings.)
9. J.N-, aet. 24, was admitted to the Manchester Royal Infirmary on May 5th, 1886, under the care of Dr. Ross.
a. Previous history.- The patient is an unmarried man, and never suffered from any serious up to the date of his present illness. He has always been well clothed and fed, has never in any alcoholic excess, and has for a considerable time before admission been a total abstainer. He has never been infected with syphilis. The patient is of Irish extraction, but has lived in Salford for the last eleven years. During the greater part of the time he has been in this country he was employed in a calico- printing works; but being out of work about eight months ago, he obtained a temporary engagement in an india-rubber factory. In his new situation he was employed in the “curing room,” where he inhaled the fumes given off from certain chemicals used in the process of manufacturing, and said to consist chiefly of bisulphide of carbon. After working for a few weeks in this place the patient suffered from a burning sensation in the hands and face, and these were also hot to the touch and of a red colour. He found, however, that when he put his hands in cold water they immediately turned of a lived colour, and became cold and numb as if they were dead, or, as the patient at another time expressed it, “they looked just as if they had been frost-bitten.” In consequence of the effect cold water had upon his hands, and to a less extent upon his face, he was obliged to wash himself in warm water. On getting home at night he suffered from a fidgety and restless feeling, which prevented him from being able to sit still for more than a few moments at a time. After working for a few weeks longer the patient experienced tingling sensations and numbness in his feet and hands, his legs began to feel heavy and feeble, and he noticed a considerable degree of weakness of both wrists. He continued, however, weakness of limbs he was at last obliged to desist. The patient now rested for complete recovery, and then turned to his old work in the “curing room.” He was, however, not many weeks at work before he felt the old uncomfortable sensation in the hands and feet, while the weakness soon became much greater it had previously been. He now experienced the greater difficulty in walking, and could scarcely hold anything in hands, which, besides being feeble, trembled a good deal, more especially when he attempted to grasp anything. The senses of sight and hearing remained unaffected, but everything seemed to smell of the vapours of the factory even when he was away from his work, and his food seemed either to be tasteless or to taste only of the gas. The patient loathed the sight of food; he lost a stone in weight, and observed that the wasting of his legs and arms was out of all proportion to that of the rest of his body. On leaving his work in the e. he often walked like a drunken person, and talked a good deal of nonsense. He had at all times a stupid feeling, and his memory failed almost completely, while at night he was restless and his sleep was disturbed by horrid dreams. In the morning he felt thoroughly miserable and depressed, and was glad to get back to his work, as inhaling the gas brought some relief, at first at least, to his feeling of wretchedness. The patient at last got so feeble that he could scarcely walk at all, and for the last four weeks he ceased to go to his work. He, however, got a temporary engagement at a tarpaulin manufactory, but he soon found he was unable to do the work owing to the weakness of his hands.
b. Present condition.- The patient is a tall and fairy well- nourished man, but the muscular of the extremities are considerably wasted, the emaciation being specially marked in the muscles of the legs and those of the forearms. When the forearms are held out horizontally in the prone position the patient experiences considerable difficulty in maintaining the hands extended on the forearms and the fingers at the metacarpo- phalangeal articulations of the extensors and causes flexion at the wrist. When he grasps any object the hand becomes bent forwards on the forearm, and the greater the effort the patient makes to compress the object the more pronounced dose the flexion at the wrist become, thus showing a predominance in the strength of the flexors of the arms, and the shoulder-muscles are comparatively unaffected. The patient can only extend the small toes very feebly at the metatarso-phalangeal joints, and when he is sitting on a chair with his feet flat on the ground he is unable to raise the ball of either foot. When sitting on a table with the legs pendulous the toes drop so that the backs of the feet are almost in a line with the anterior surfaces of the legs, or only form very obtuse angles with them. On being seated on a chair the patient can with considerable effort extent the leg on the thigh and raise the heel from the ground, but the slightest pressure on the leg, the thigh being supported, causes flexion at the knee-joint. The patient can draw the knees together with considerable force by the action of the adductors of the thighs, but separation of them is only effected in a feeble manner by the abductors. Flexion of the leg on the thigh is performed with great power, but the patient experiences considerable difficulty in attaining the erect posture, having to assist himself with his arms either by holding some article of furniture, or by grasping his thighs and pushing up the trunk as is done in pseudo- hypertrophic paralysis, thus showing that the extensors of the body upon the thighs are feeble. On standing erect the patient maintain his feet about fourteen inches apart in order to widen his base, and on being got to place them side by side along their inner borders he sways slights from side to side, and these swaying movements become greater when the eyes are closed, but he can still maintain the erect position, although the manifest effort. The gait of the patient is the one which has been compared by Charcot to that of a high-stepping horse, and by Schulz to that of a dancing master. The chief peculiarity of this gait is caused by the fact that the muscles which produce dorsal flexion of the foot are paralysed. Let us suppose that the patient has advanced the right foot and planted it firmly on the ground. The abductors of the right thigh now contract and the line of gravity is transferred to that side, so that it passes through the arch of the right foot, which is now the passive one, the heel is slightly elevated so that the toes almost rest on the ground, while there is the slightest possible flexion at the knee-joint, and a still less at the hip-joint. In ordinary locomotion a slight dorsal flexion of the foot would now be produced, the toes of the passive foot would thus be raised from the ground and the limb would swing forwards by its own weight without muscular action. The patient, however, is unable to produce dorsal flexion of the foot, and, consequently, compensatory movements have to be effected in order to clear the toes off the ground. These movements consist of an unusual degree of flexion of the thigh upon the trunk, and of the leg upon the thigh, which cause a shortening in the length of the whole limb. The heel of the passive foot become raised from the ground in direct proportion to the elevation of the knee-joint by the flexion of the thigh on the body, but owing to the paralysis of the anterior muscles of the foot the toes continue to drop until further depression is arrested by the anterior ligaments of the ankle-joint. The consequence of the continued drooping of the toes while the heel is being elevated, is that an observer, standing behind the patient, sees more of the sole of the foot at each forward step than in ordinary locomotion, and, on standing laterally, notices the drop of the toes and the unusual elevation of the knees with each advancing step. When the patient is laid in bed the feet assume the position of a double ankle drop. The small toes are hyperextended to a very slight degree at the metatarso-phalangeal joints, but the big toe is flexed at both the metatarso-phalangeal and the phalangeal joints. The patient can voluntarily extend, to a slight degree, the small toes at the metatarso-phalangeal joints, and can produce a little aversion of the foot, but he is quite unable to produce dorsal flexion at the ankle-joint, extension of the big toe, or inversion of the foot, but he is quite unable to produce dorsal flexion at the ankle- joint, extension of the big toe, or inversion of the foot on either side. These observations show that a slight degree of motor power remains in the long extensors of the toes and the peroneal group, but that the extensors of the big toe and the tibialis anticus are completely paralysed. The consequence of this distribution of the paralysis is that of the sole of the foot is not only directed backwards towards the plane of the bed, owing to paralysis of the muscles causing dorsal flexion of the foot, but that it also has a slight inclination outwards, or is somewhat everted, because the peroneal muscles have still retained some degree of motor power, while the tibialis anticus is completely paralysed. The paralysed nerves and muscles react to a moderate strength on the faradic current, and, indeed, it can hardly be said that the faradic contractility is even lowered. The extensors of the toes on the right side give a minimum contraction on cathodal closure to 20 cells and on anodol closure to 15 cells, and on the l. on both cathodal and anodal closure to 20 cells Leclanche. In the extensors of the thigh and those of the forearm anodal closing contraction is equal to or greater than cathodal closing contraction. The reflex of the sole is absent, but the other cutaneous reflexes are normal. The patellar tendon reactions are absent. The patient complains of a feeling of numbness and tingling in his toes and feet in the tips of his fingers, but the sensations of pain, touch, and temperature are found to be normal, or nearly so, to objective examination. Pinching of the skin over the external aspects of the legs appears to cause an unusual degree of pain, but there is no undue sensitiveness of the muscles of palpation. The patient complains that he has no proper taste for his food, but he readily identifies salt and sugar when placed on his tongue. He also says that his smell is blunted, but he recognises camphor when a piece is applied to his nostrils. The sense of hearing is normal.
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.