c. May 27th.- The condition of vision was examined by Dr. Little this m., and he reports as follows: “The patient does not complain of and defect of vision. The acuteness of vision is normal in both eyes, and the fundi are apparently healthy. The perimetric chart of the field of vision for the right eye shows a considerable restriction for all colours. A general examination of the l. eye shows that it is similarly affected.” Beyond the muscular wasting no trophic changes are noted. The hands, when warm, are reddish, and are moist and clammy to the touch, but when placed in cold water they immediately assume a livid colour, and become cold, looking just as if they had been frost-bitten, or in the early stage of Reynaud’s symmetrical gangrene. The patient lost all sexual desire a few weeks after he began work in the “curing-room,” and even at the present time he never has any erections. The loss of this function was not preceded by a stage of sexual excitement. No marked physical symptoms have been observed, although the patient complains very much of loss of memory.
d. The treatment adopted consisted of rest, good nourishment, massage, and galvanism. A tonic mixture was prescribe, with the view of aiding digestion. During a residence of a month in the Royal Infirmary the patient improved considerably, but he was still unable to produce dorsal flexion of the feet, and the patellar-tendon reactions remained absent. He was now sent to the Convalescent Hospital at Cheadle, and 6 weeks afterwards appeared as an out-patient at the Infirmary, when scarcely a trace of the previous paralysis could be detected. The patellar-tendon reactions had appeared, but were still sluggish, and dorsal flexions of the feet, although capable of being effected, were not produced with normal strength. The patient soon afterwards disappeared from observation. (Medorrhinum Chronicle, Dec., 1886.)
10. P.S-, aet. 36, was admitted to the Manchester Royal Infirmary, under the care of Dr. Ross, on May 12th, 1886.
a. Previous history.- The patient is of Irish extraction, but he has lived in Pendleton for the last twenty-four years. He is a moulder, and was always engaged at his own trade until work was scarce at the beginning of last winter, and up to that time he enjoyed good health, never being laid up for a day with any kind of illness. The patient has always been well fed and clothed, and although he is not a total abstainer, he has never indulged in alcoholic excess, and was not a heavy smoker. He has been married 8 years, and has one child, who is living an healthy. His wife never had miscarriages or still-born children, and there is nothing in his history pointing to syphilis. About 9 months ago, being out of work, he obtained employment in an india-rubber factory, and worked in the “curing-room,” where he was exposed to fumes supposed to be bisulphide of carbon gas. He worked for 3 months in this place before he felt any ill effects from the gas, but at the end of this months his appetite completely failed, his food tasted of the gas, and everything about him seemed to smell of it. He soon found himself unable to read, the letters seeming to run into one another. He also became deaf in the l. ear, but he thinks the right was not any time much affected. His lower limbs now felt heavy, and he became so feeble in a short time that he could scarcely walk, and occasionally fell down. About the same time he experienced tingling sensations and numbness of his hands; they also began to tremble, and his grasp was so weak that he could scarcely hold anything. He also experienced similar tingling sensations in the toes, and his feet felt so numb and dead that it seemed to him as if he were treading on something soft instead of on solid ground, and walking, at all times somewhat uncertain, became specially insecure in the dark or on closing his eyes. His sexual appetite failed entirely after working for a few weeks in the “curing- room,” and this loss was not preceded by a stage of undue excitement. On putting his hands in cold water they immediately became numb and white as if they were frost-bitten. It is difficult to ascertain from the patient’s description whether he suffered from genuine cramp in the legs or from the pains shooting along the course of the nerves, or from both of these disorders. He suffered at least from some kind of pains in the lower extremities which caused him on going to bed to wish for a frequent change of the position of his legs, and greatly disturbed his rest, while the snatches of sleep he obtained were disturbed by horrid dreams, in which he fancied himself surrounded by cats and other animals. In the morning he got up drowsy and unrefreshed, and suffering from an intense headache, chiefly limited to a spot in the forehead and between the eyes, which lasted with more or less intensity throughout most of the day. He was, indeed, so utterly miserable and mentally depressed on getting up that he wished himself dead, and at the same time had a longing to get back to his sufferings. After breathing the gas for a short time his mental depression gave place to a joyous feeling which was but short-lived, being replaced in the afternoon by an indescribable feeling of apathy and wretchedness. The patient’s memory failed very much, his recollection of recent events being specially defective. He sometimes found himself taking nonsense while at his work, and he occasionally fancied that he was surrounded like the same degree as some of his fellow-workmen. He says that some of the workmen when under the effects of the gas become very loquacious, and at other times talk a great deal of nonsense. One man on coming to his work in the m. told his comarades that he was in Liverpool the previous night, a statement which could not possibly have been true. Another workman, apparently to escape from some imaginary danger, jumped through a window, ran across an open court, and having crept under a joiner’s bench, tried to hid by covering himself with shavings. One or two of the workmen have gone quite mad, and have been sent to a lunatic asylum.
b. Present condition.- When the patient is seated on a chair, with his feet flat on the ground, he is unable to raise his toes off the ground by dorsal flexion of the feet. He has sufficient strength to extend the leg on the thigh, and to raise the heel off the ground, but the slightest pressure on the front of the leg suffices to cause flexion at the knee-joint when the thigh is supported. When the forearms are held out horizontally, the hands being in the prone position, the patient can, with much effort, maintain the hands extended upon the forearms and the fingers extended upon the hands, but the slightest pressure on the backs of the hands cause flexion at the wrists, and on the back of the fingers flexion at the metacarpo-phalangeal joints. When the patient is laid on his back in bed there is double ankle drop; the big toe is flexed into the sole at both joints, but the small toes are slightly hyperextended at the metatarsal- phalangeal and flexed at the phalangeal joints. It is, indeed, unnecessary to describe in detail the distribution of the paralysis in the case of P.S-, in as much as it corresponds in almost every particular to that observed in the case of J.N.-, just reported, the gait of the former being also so like that of the latter as to make a separate description superfluous. When the patient stands with his feet approximated and with closed eyes, he sways from sided to side and maintains the erect posture with manifest effort. The following reaction were obtained in the affected nerves and muscles to electrical examination: -The faradic irritability was diminished in the extensors of the forearm, and in those of the legs and thighs, as well as in the nerves which supply these muscles, but all the nerves and muscles reacted to a moderately strong current. The patient complained of numbness and tingling of the hands and feet, and there was a slight diminution of the sense of pain, as tested by pricking, and of touch, as tested by separate points, in the outer aspects of both legs and feet, but the temperature did not appear to be affected. The various forms of cutaneous sensibility were found to be normal in the remaining parts of the body. Moderate compression of the affected muscles did not cause pain. On being asked to touch, with closed eye, his nose, with the tip of of his index finger, he touched somewhat wide of the mark at first, but effected the movements accurately with a little practice. The reflex of the sole was absent, but the cremasteric and other cutaneous reflexes appeared to be normal. The patellar-tendon reactions were absent. The patient is able to distinguish salt, sugar, and quinine, when placed upon the tongue, and he also recognises camphor when applied to his nostrils, but he says that both of these senses are very much blunted, and that everything seems to taste or smell of the gas. He hears the ticking of a watch on the right side when it is two feet from the ear, but not on the left side until contact is made. There is no undue collection of wax in the external meatus, and no discoverable disease in the tympanic membrane or external ear.
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.