57. W-, an arsenic-eater, reports that on leaving it off for 2 or 3 d. he feels slight languor and loss of appetite. On two occasions he tried to leave it off altogether. The second time, on 3rd day of 2nd week after cessation of drug, he was attacked with faintness, depression of spirits, mental weakness, and a total loss of the little appetite he still had; sleep also entirely left him. On 4th day he had violent palpitation, accompanied by profuse sweat. Inflammation of lungs followed, and he was laid up for 9 weeks. The results on the former occasion were very similar. (HEISCHE, Pharm. Journ. and Trans., 2nd ser., i, 556.)
58. The solution, when administered in small doses, will generally be attended with no operation; yet it will frequently produce a nausea, often accompanied with a slight griping, or an open body; seldom with vomiting or purging. When it is given in large doses, especially if three times a d., it will generally excite a nausea and vomiting, or a nausea with griping and purging; and sometimes these effects are combined. Certain swellings, especially of the face, [ “Under the influence of continued small doses a characteristic puffiness of the face arises, with oedema of the eyelids, which at first is most visible in the morning, but it afterwards more permanent and extensive, occupying the ankles, limbs, and abdomen with a dropsical effusion” (STILLE). See also Edinb. Medorrhinum Journ., v, 15; IMBERT-GOURBEYRE, Action. de L’Arts. sur la peau, ch. xiii; and WEIR MITCHELL N. York Medorrhinum Journ., i, 169 (ii, 51, 52 here).] or a loss of appetite, will sometimes attend the larger doses, and now and then even the smaller ones. In several instances it has proved evidently diuretic; yet in two or three it has seemed to diminish the natural urinary discharge. In a few cases it has occasioned an uneasiness and pain at the stomach, or a slight general eruption like the nettle-rash; and in a very few instances it has seemed to produce a sweat, a headache, or slight tremors. (FOWLER, Medorrhinum Reports of Effects of Arsenic, 1806, p. 94. From observations on 320 cases.)
59. M. Devergie has been the first to call attention to a phenomenon which appears at the subsidence of squamous diseases, and especially psoriasis, treated by arsenical preparations; the surface affected takes on in its whole extent a brown tint which does not vanish for several months. Moreover, under the influence of the same medication, there will manifest itself on the arsenical spots a secondary eruption consisting of certain pimples, red and isolated, multiplying slowly, but (if the drug is persisted with) continuously. On this point my personal experience is in entire accord with that of Mr. Devergie. In some much rarer cases we may observe, after the internal administration of A., pustular, ecthymatous, furuncular and ulcerous eruptions. (BAZIN, Affections cutanees artificielles, 1862, p. 194. At p. 196 Bazin relates a case in which ecthyma- like pustules appeared after the consumption of gr. 5/6th of A. during 14 d.)
60 a. A full dose of A. being administered at regular intervals, in a few day (or possibly weeks) a prickling sensation is felt in the tarsi, and the conjunctiva becomes slightly inflamed. At this crisis the disease is brought under arrest…. The dose may now be reduced, and in some case a very small dose taken with exact regularity will suffice to keep the eyelids slightly tender and the skin healing…. A slight degree of conjunctivitis, in about 49 cases out of 50, takes precedence over the more grave affections-gastritis, colicky pains, vomiting-which indicate an over-dose…. [ Dr. ROBERTS, in his Theory and Practice of Medicine, relates a case of pityriasis rubra caused by A. (2nd ed., p. 793) ] In exceptional cases, tenderness of the soles, and more rarely of the palms, presents the first indication of an over-dose.
60 b. Whereas conjunctivitis is the primary effect of small doses of arsenic, it has also after a time a secondary effect. The trunk of the patient first, and subsequent all those parts of the body which are by the dress protected from the access of light and air, become covered with a dirty brown dingy, unwashed appearance, which, under a lens, reveals a delicate desquamation of the dermis, and is, in fact, a faint form of pityriasis…. Now and then a delicate papular eruption (lichen arsenicalis) will show itself suddenly under a course of A. and as suddenly disappear under a few doses of the liq. amm. acet.
60 c. Excessive doses often produce so strong and lasting an impression on the nervous system, especially in delicate subjects, as to render it, for months or years subsequently, so intolerant of the medicine, even in the smallest doses, as absolutely to interdict its use. After a week or two of 5 min. of Fowler’s solution 3 times a day such patients complain of nervous tremors, disturbed rest, horrible dreams, and other affections of the sensorium. (HUNT, Diseases of Skin, 5th ed., p. 20-25.)
61. I have seen very minute doses of A. given to patients affected with lepra, and continued for many days, without being able to detect the least indication of its action on the system, except the amelioration of the disease. When the dose was slightly increased the appetite in some cases appeared to be increased; but the effect was neither universal nor continued. Very shortly afterwards, a sensation of heat in throat, esophagus, and stomach, came on, occasionally with nausea, but seldom with vomiting; in a few cases, with gastrodynia, a febrile condition of the body was set up; there were dryness of skin, increased secretion of urine, relaxed bowels, sometimes with griping; the patients usually complain of great languor, inaptitude for employment and want of sleep; and sometimes these symptoms were accompanied with, or followed by, pricking or irritation of the tarsi, redness of the eyes, a slight degree of conjunctivitis, and certain swellings, especially of the face (edema arsenicalis). (PEREIRA, op. cit.)
62. The single or not often repeated administration of small doses (0.001-0.005 grm.) gives rise to rather vague symptoms, varying in different individuals, and with difficulty recognizable for appreciable. There is feeling of warmth in esophagus and stomach, and appetite is increased so that there is feeling of hunger. The various functions are more energetically performed; among them those of heart and brain, respiration and temperature, and those of the excreting and genital organs. But if even these small doses are continued for a long time, serious symptoms of poisoning set in. There is feeling of constriction in throat, dryness there and in mucous membranes generally, pain in region of stomach, nausea, vomiting, and purging; there is also fever accompanied by headache and sleeplessness. When the drug is suspended the health may be entirely restored. (NOTHNAGEL and ROSSBACH, op. cit.)
63. Even medicinal doses, if long continued, will induce in some persons a dyspnoea allied to that of emphysema, or even asthma, with dry cough or hawking of mucus. This I have verified several times in the subject of eczema, observing its cessation with the omission of the drug, and its return under arsenical influence. (PHILLIPS, op. cit.)
64. When A. is given in medicinal doses one of the first constitutional symptoms produced by it is an acceleration of the heart’s action; this, as Dr. Duffin has remarked, and as I have seen, sometimes becomes quickened after a few day by 10, 20, or 30 beats per minute, the pulse also becoming hard and wiry. [ This hardness (there called “sharpness”) of pulse was noted in a case of poisoning by Dr. Ward, and after death heart was found smaller than usual, and hard like a spasmodically contracted (Edin. Medorrhinum and Surg. Journ. xxxiii, 61). ] This acceleration is particularly observable in those of sanguineous or sanguineo- nervous temperament, in whom the heart’s action is readily excited by physical exertion or mental emotion. In some cases before, but usually after, this acceleration, there appear evidences of irritation of the mucous membrane of the stomach; there will be more or less thirst; the tongue becomes coated towards centre and root, with red sides and tip; loss of appetite and sense of weight in the epigastrium; about the same time there will be heaviness and pricking about the eyelids, with flashes of light before eyes when closed, and after a time eyelids become puffed and droop, giving the countenance a peculiarly melancholy and careworn appearance; there will be more or less headache, chiefly over brows and lower part of forehead; this headache is very often one of the first symptoms. There are very commonly confused and horrible dreams, especially in children. Girdlestone has remarked that in some cases the skin assumes a uniform lobster-red colour, that erysipelas comes on, or that phlyctenae and pustules appear. I have frequently seen that the disease of the skin for which A. is given more particularly if it be chronic eczema, has evinced a decided tendency to increased action, the patches becoming red and irritable. If the A. is still continued there results great irritation about mucous membrane of stomach and throat; headache increases in severity; urine high coloured; countenance, which has become pale and sallow, will assume a remarkably sorrowful, and anxious cast; tremors of limbs come on, with an occasional feeling of faintness; and the foundation of incurable and permanent disease may be laid in nervous or digestive system. In some cases the first symptoms is a degree of thirst and feeling of oppression about epigastrium; in others, and this is very common, headache with disturbed dreams; and, usually antecedent to, or coincident with, any one of these symptoms, acceleration of pulse. A young lady took Fowler’s solution for psoriasis of legs to such an extent that it caused excessive derangement of stomach, followed by a violent neuralgic attack, together with, at a subsequent period, a distressing train of hysterical symptoms which terminated in a state of dementia, which has now lasted nearly four years. A. is very badly borne by plethoric or highly sanguine or sanguineo-nervous people. In these cases the pulse becomes rapidly accelerated; irritation and even subacute inflammation of gastric mucous membrane supervenes; there is headache, and a sense of tension or weight in forehead, and the skin disease becomes aggravated. (ERICHSEN, Medorrhinum Gazette, 1842, ii, 196, 238.)
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.