2 a. A porter of the Ophthalmic Hospital in Moorfields took 3ss of liq. belladonnae in mistake for the fluid extract of sarsaparilla. He did not immediately discover his error, but in 5 min. or thereabouts after it had been committed he was rendered sensible of his mistake by the unexpected occurrence of a sensation of heat and dryness in the throat, succeeded very soon by vertigo and slight aching pains in the limbs, but no headache. Upon the appearance of these symptoms, he immediately ran across the street, a distance of about 100 yards, to the residence of his usual medical adviser, for assistance, and was by that gentleman directed to return to the hospital and drink warm water until the stomach-pump could be got ready. The man did as he was told, and vomited on his return before the pump could be applied; but whilst in the act of drinking he became powerless, and in less than 1/4 h. after the accident delirious and insensible. He struggled violently in his unconscious state, and the combined strength of several men was required to hold him steady during the operation of pumping out the contents of the stomach.
2 b. The stage of delirious excitement was brief; and whilst in a comatose state the patient was sent to St. Thomas’s Hospital, and placed under my care. When the patient was first seen by me at 10:30 a.m. he was nearly unconscious of surrounding objects; he was lying supine, and all his limbs were equally powerless. There was no hemiplegia; his face was full and flushed; the head and general surface warm; the pupils widely dilated, scarcely any iris could be seen, and the retina was quite insensible to the stimulus of strong daylight. The palpebra of the left eye were puffy, and redder than those parts on right side; and the upper left lid was prolapsed, as in ptosis. The breathing was stertorous, and the respiratory sounds, hastily examined over the anterior parts of the chest, were modified by rales. The action of the heart was feeble, and the pulsations of the radial artery were 116 in the m., regular, and weak. The tongue could not be seen. The abdomen was rather contracted, and no distension indicating an accumulation of urine existed. The sensibility of the pharynx was so much impaired, and deglutition so imperfectly performed, that, on introducing a warm infusion of coffee into the patient’s mouth, the liquid collected about the larynx, and his features became alarmingly turgid in consequence of impeded respiration.
2 c. Under the influence of treatment an amendment, indicated by a diminution of heat and fulness of face, and by returning consciousness, took place in the course of a few h. after the patient’s admission; and about 3 p.m. he made an attempt to articulate the monosyllables “yes” and “no” when roused by questions. The amendment, however, was only temporary; for, in the e., violent delirium succeeded the stupor, and recurred a second time. The patient continued very unmanageable during the n., and could only be restrained with safety to himself and the neighbouring patients by means of a strait waistcoat. This state of excitement was protracted till about 3 next m., when he again became calm, and a decided abatement of all the urgent symptoms was noticed at 8 a.m.
2 d. At 1 p.m. he had regained the power of speech and deglutition; and although a peculiar wild expression of countenance remained, with confusion of ideas, he was sensible enough to thank his medical attendants for the aid they had afforded him. The tongue could now be protruded; the pulse had subsided from 116 to 68, and did not subsequently undergo any material variation. The sight of the right eye had become rather clearer, but that of the left eye more impaired; the upper lid more tumefied and prolapsed; the conjunctiva more vascular, and raised above the margin of the transparent cornea, which, in a few days, became opaque; and a small quantity of puriform fluid had accumulated in the anterior chamber of the eye. The sight of the left eye was perfectly natural previous to the accident; and as no mechanical injury has been since done to it, its inflammatory state may be fairly attributed to the virulence of the B.
2 e. All anxiety for the immediate safety of the patient ceased within 30 h. after his admission; but the abnormal condition of the nervous system prevailed several days, and notwithstanding he conversed rationally on the second d., he had no recollection of the events which occurred in St. Thomas’s Hospital until near 60 h. from the commencement of his first delirium, or the third day of the accident. After recovering perfect consciousness, a remarkable numbness, extending over all parts of the trunk and extremities, attracted attention, and persisted for several d. No pain could be excited, while this condition continued, by forcibly pinching the skin of the forehead or of other parts; and although an unusual sensation was perceived by the patient at the moment, he could not, with his eyes averted from the operation, point out the precise spot subjected to compression. Anaesthesia co-existed with consciousness, resembling the state often recognized during recovery from the effects of chloroform. The specific sensibility of the right retina was not entirely restored until after common sensation had returned to the general surface; and the sight of the inflamed eye continued dim, from the events of the secondary affection, until a later period.
2 f. The mental delusions during the delirium were for the most part, though not altogether, of an agreeable kind; and the prevalent fancy in the patient’s mind was that he had become suddenly rich and possessed of a splendid mansion. (BURTON, Lond. Medorrhinum Gazette, 1848, p. 1024.)
3 a. Miss G., aet. 34, of slight figure, fair complexion, nervous temperament, swallowed by accident 3j of extract in 3iss of soap liniment. At first she only complained of “a sensation of madness in her brain,” but in less than an h. lost the power of speaking and swallowing quite suddenly, and fell into a comatose state. Mr. E, found her with head bent forward on chest, speechless, eyes, closed, breathing heavy and stertorous, pupils widely dilated, hands and feet cold, pulse scarcely perceptible, jaws firmly fixed; there was a constant disposition to raise the hands to the face. She appeared conscious when roused and addressed, but could not answer; nor could she swallow when liquids were put into the mouth. After emptying the stomach with the tube, and introducing coffee and ammonia, there was some reaction.
3 b. 12 m., there seemed to be a gradual improvement in her breathing, circulation, and general appearance; there was a slight twitching of the muscles of the right side of the face; not able to swallow, but we fancied she, in answer to a question put to her, said “yes.” 5 p.m., symptoms the same; no evacuation from bladder or bowels; pupils widely dilated and immovable; has slept a good deal; skin warm; pulse 112, feeble; still unable to speak or swallow. 9 p.m., countenance more natural. There was constant nictitation, and picking at the sheets; if touched by any person she jumped as if in great alarm. This I observed to occur whenever her hair was removed from her face, or when I felt her pulse. When thoroughly roused she answered in monosyllables, and apparently attempted to form connected expressions, but they were unintelligible; pupils still greatly dilated, nor did they contract when a lighted candle was placed before the eyes; pulse 120; no action from bladder or bowels. On asking her if her throat was sore she replied, “dry;” on asking her if she could suck an orange, she replied, “yes.” I therefore had some orange- juice squeezed into a glass, and, by means of a teaspoon, got her to swallow perhaps half an ounce; but this was accomplished with great difficulty. Ordered an injection of a pint of gruel with half an ounce of oil of turpentine and an ounce of castor-oil to be administered directly, and, when able to swallow, the following mixture:-Spirit of nitric ether, 3iij; compound tincture of cardamoms, 3ij; camphor mixture, 3vss. To take an ounce every 3 h.
3 c. January 9th, 11 a.m. Has passed a restless night, sleep being much disturbed by frightful dreams; complains of intense pain in the head, and says that it feels enormously large, as also does her throat; is much annoyed by a constant sensation of trembling in all the muscles of the body; bowels were moved after the injection, and some urine passed at the same time, none since; great intolerance of light and noise; tongue rather dark, but moist; skin natural; complains of thirst; pulse 88; pupils as dilated as ever. She says she can see me for a moment only, and then my face becomes horribly distorted. The power of speech seemed to return about 12 or 1, at which time she was very delirious, and would persist that there were very horrid monsters all over the room staring at her. Ordered 8 leeches to the temples; effervescent mixture every three h., and 2 grs. of calomel, with 7 of extract of colocynth, to be taken directly. She says she remembers my coming to her yesterday m., but was unconscious of everything afterwards until the e.
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.