19. MOLL took doses of crystals from gr. ss to gr. ij. They caused first disagreeable sensation of stoppage in gullet and stomach; then feeling of warmth in stomach, with rumbling in bowels and escape of flatus. In larger doses drug occasioned compression of stomach, weight at scrob. cordis with involuntary urging to sigh, palpitation, tremor of limbs, general prostration, giddiness and singing in ears. There was usually added to these remarkable dryness of tongue, intense thirst, annoying choking at gullet, and obstinate constipation. (Handbuch der Pharmacologie, ii, 133.).
Poisonings
1. E. H-, et. 21, was brought to the St. Louis Hospital in a seemingly moribund state, from having swallowed a solution of arg. nit. The patient presented the following symptoms: Complete loss of consciousness; insensibility of all parts of body; upper limbs and facial muscles agitated by convulsive movements; jaws firmly clenched, eyes turned up, pupils much dilated and insensible to light; pulse full, natural, 70. There were stains of nitrate of silver on the fingers. A glass of a solution of salt (1/2 drachm to the ounce) was administered every 1/4 h. He had received much magnesia and inert matters before admission. Towards 3 a.m. an amelioration was manifest; muscles of face no longer agitated, jaws relaxed, pupils less dilated. 6 a.m., continued insensibility of lower limbs, sensibility obtuse in upper; face strongly injected; patient experienced violent pains in epigastrium. 8 a.m., no change in appearance; sensibility a little less obtuse. Asked about quantity of poison he had taken, he could not answer, but indicated it by sign of figure “8.” The administration of salt solution was kept up all this time, and now he was limited to emollient drinks. Noon, sensibility returned in all parts of body. Epigastric pains. The patient recovered speech. He said he had taken 8 drachms of fused silver suspended in cassia water. 3 p.m., he fell into coma difficult to describe, lost intelligence and sensibility, pulse 95. This lasted 2 h. 7 p.m., sensibility and intelligence had reappeared, and the patient passed a fairly tranquil night. At 8.24 a.m., he fell again into his habitual coma, persistent loss of intelligence and obtuse sensibility. At noon he was found in a satisfactory state; he complained of epigastric pains, but the sensibility and intelligence had reappeared; by evening he could raise himself up and drink without help. On the 25th, about 9 a.m., the patient experienced a new crisis, but much less strong than the preceding, and in the evening he was found playing cards with his neighbours. The following d.s he steadily progressed, but felt violent epigastric pains up to his departure on the 29th. (POUMAREDE, Journ. de chim. med., 1839, p. 434.)
2a. A medical pupil, while touching a small ulcer beneath the tongue of a child aged 15 months with a stick of nitrate of silver, 3/4 inch long, which he held in his fingers by one end wrapped in paper, had the misfortune to let it slip down the child’s throat. Almost immediately the child vomited some oily matter supposed to be cod-liver oil and milk, the oil having been taken shortly after breakfast. When the vomiting had ceased, and within a few m. of the caustic being swallowed, common salt was given in considerable quantities, after which the child was slightly convulsed. Again vomiting took place, and now the matter ejected had a white curdy appearance, and no doubt was principally chloride of silver. The administration of salt was repeated frequently. Vomiting and convulsions occurred at short intervals till 11:30. (The caustic had been swallowed at 9:30.) At that time there was a copious liquid stool containing a quantity of the white curdy substance. At 1 p.m. the child fell into a composed sleep which lasted for 1/2 h., after which convulsions returned with increased violence and continued until 3. The extremities then became cold, the face pinched, the skin clammy, and the pulse almost imperceptible; the child died in violent convulsions at 3:30 p.m., 6 h. after swallowing the poison.
2b. Post-mortem exam., 25 h. after death. -Child was well nourished and appeared to have been in good health. Cadaveric rigidity well marked. Under the tongue a small hard swelling, ulcerated on the surface, corresponding to the orifice of Wharton’s duct. No marks of nitrate of silver in the mouth, but in the esophagus two or three small patches of corrosion. The stomach contained 2 1/2 oz. of inodorous fluid; mucous membrane pale except one point of ecchymosis, and a large patch of corrosion, interrupted transversely in several places, but extending from the cardiac opening along the greater curvature for 4 in. It was 1/2 in. wide at the cardiac end, and 1 1/2;in. at the end nearest the pylorus, and was of a brilliant white colour. In the duodenum and the first 12 in. of the jejunum, the valvulae conniventes presented a similar corrosion over nearly their whole surface, but of a greyer colour. This was not washed off by a gentle stream of water, nor by rubbing with the finger, by which, however, loose white particles were removed. There were no morbid appearances in the other parts of the alimentary canal, in which about 3 oz. of fluid were contained. The other viscera were healthy. Heart empty and contracted. Mucous membrane of trachea normal. The contents of the stomach, ileum, and rectum, were separately analyzed. In each there was a considerable quantity of chloride of sodium, most in the stomach, and least in the rectum; and of course, therefore, in none of them was there any nitrate of silver. The white patches rubbed off the corroded spots in the stomach and off the valvulae conniventes proved to be chloride of silver. (SCATTERGOOD, Brit. Medorrhinum Journ., 1871, p. 527.)
3. In large doses it sets up nausea, vomiting, diarrhea, with colic; mostly also symptoms of an intense disturbance of the nerve-life of the whole economy, great faintness and depression, often stupor, want of breath. Sometimes there are cramps, convulsive contraction of this or that set of muscles, even paralysis of the limbs. (OESTERLEN, Hahndb. der Pharm., 1856, p. 128.)
4. Nitrate of silver gives rise to heat in the pharynx, and irritates the digestive organs by its immediate impression on the mucous surfaces. It frequently excites colic and alvine evacuations the first time that it is taken. It has been seen to produce vertigo and transient blindness. It has caused an increased secretion of urine. (BARBIER, Traite de. Mat. Medorrhinum, p. 588.)
5. A woman aged 58, widow, and mother of several children feeble indeed, but otherwise enjoying continuous good health, noticed in the year 1857 that her hair was growing grey, and endeavoured to hide this mark of commencing old age by the use of a pomade compounded with lunar caustic, which she applied every fortnight. In January, 1860, the following operations of the cosmetic came out; dyspnoea and palpitation; soon after, edema of lower limbs and ascites: the forces failed, and the patient was compelled to keep her bed. [ Roge also relates a case in which an epileptic having taken arg. nit. longer and (he suspects) in larger quantity than he intended, her health suffered materially in consequence; she became emaciated, and was reduced to a state of alarming debility, from which she was several months in recovering. (COOKE, Nervous Diseases, ii, 2, 151)] After the lapse of a month, the edema of the lower limbs was removed, but in place of it a slate-grey colouration of the skin appeared, which, like the ascites, remained permanent. On June 15th, 1860, the patient was brought into the hospital when the following symptoms presented themselves: The skin of the legs showed, besides the slate-grey colouration, a hardness and tension which made it impossible to raise up the skin in folds, so that it assumed the complete character of brown sclerema; nevertheless the sensation, temperature, and transpiration of these parts were normal. The legs were bent up towards the upper part of the thigh through contraction of the muscles, and were in such an advanced state of emaciation that they looked like the legs of a mummy. On the upper part of the chest and on the hands appeared a faintly- marked brown colouration. Auscultation of the heart and arteries gave the signs of commencing anemia. In other respects all the organic function are performed regularly and satisfactorily; there was only a slight degree of ascites; and the urine, which was passed in normal quantity, and without inconvenience, was in no way abnormal in its constituents. At first sight it might be doubted what was the nature of the peculiar colouration of the skin, and especially it might be thought to be Addison’s disease;i in the meantime the characteristic colour of the hair and scalp soon led to the r. track, and in answer to inquiries the above-mentioned history was given. Here, through the use of a pomade of nitrate of silver the same effect was called forth as in other cases following the internal use of argent. nit. that a deposit of nitrate of silver under the skin really ensued, was also established by this means, that by repeated application of a solution of iodide of potash the skin-colouration was made decidedly clearer. The ascites was undoubtedly owing to the anemic condition, [ Wedemeyer relates, in Rust and Caspar’s Repertorium, xix, 454, a case of argyria] which, on its part, found its explanation in the injurious action of the nitrate of silver. The indication for cure was to change the silver into a colourless and insoluble compound, as, perhaps, the iodide of silver, and by this means favour its removal from the organism. The internal administration of iodide of sodium, and the use of warm baths, had, indeed, a surprising effect, and after about a month’s use of these curative measures, the patient found herself in the following condition: The dark slate-colour of the lower extremities had become a light brown; the skin was white; the muscles had lost their contraction and permitted the extension of the legs. The light-brown colouration of the chest and hands was quite lost; the ascites, indeed, still remained, but was essentially diminished; the anemic symptoms were very much lessened by proper substantial diet which the patient was ordered. The patient was so satisfied with her condition that she would not wait for further completion of her cure, but left the hospital. (GAMBERNI, Medorrhinum Neurgkt. Ztg. 1861, p. 6. Dr. G. adds-“By the recorded cases we can confirm the observation of Lelut that the abnormal colour has its site in corium and that the epidermis is free. [ “It (silver) is never found in combination with the cellular elements, or embedded in the intercellular substance, but is rather found deposited in the basement substance of the connective tissue, and in the homogeneous membranes allied to connective tissue.” (NOTHNAGEL and ROSSBACH, op. cit) ] Herein very fixed skin alteration differs from that produced by outward contact with lunar caustic, with which the epidermis is chiefly concerned.”)
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.