16. For a long time the cumulative action of digitalis has been believed to be one of the possible results of its administration, and, at the present time, most physicians are on the alert to observe any evidence of this accumulated influence in all cases in which the drug is employed. Recently, however, there have been those who have expressed unbelief in the possibility of the occurrence of this effect after the use of digitalis, while others pay very little heed t this part of the subject when treating of the administration of the drug. While we may rightly believe that the cumulative action of digitalis is not frequently met with, I think that the following brief history will demonstrate that this sequence of its administration is liable to occur.
L. Y., aet. 6, after an attack of scarlatina occurring in March, 1877, developed albuminuria. As a part of the treatment of this pathological condition, she was ordered to receive miv of tinct. digitalis every 4 h. At the time this was prescribed her pulse had not fallen below 118. She took the medicine for 5 day with perfect regularity (except during the hours of sleep), her pulse ranging between 96 and 110. During this time the renal symptoms were improving. On the 6th day the pulse was irregular at 70. Ordered only three doses during d. On the 7th day pulse was 60 and irregular. Discontinued medicine. During the next 4 day (patient taking no medicine) pulse averaged 52, was very irregular, and, at times, was as low as 46. On the 12th day pulse became regular at 56. From this time no irregularity was observed, the frequency of the pulse gradually becoming normal. I took the trouble to ascertain that the tincture was of the same purity when the prescription was renewed, during its use, as when originally ordered. (Edward L. Partridge, N. Y. Medorrhinum Record, Aug. 17, 1878.)
DUBOISINUM.
Introduction
Alkaloid obtained from Duboisia myoporoides. Nat. Ord., Solanaceae.
Provings
a. C. E. J., in good health, pulse 68, took 5 gr. of sacch. lactis moistened with 2nd dil. of sulphate every hours from 8 a., April 27th. 11, slight tingling sensation in lower extremities as if asleep, accompanied with bad taste in mouth. 12 m., slight aching in forehead and supra – orbital region, which continued all afternoon, but stopped as soon as he discontinued taking drug. On 28th, at 11 a. m., began taking 3x dil., 10 dr. every h. There was renewal of above symptoms, and rise of pulse to 88, whereupon drug was discontinued. On May 2nd, at noon, it was resumed. 7 p. m., dryness in throat, without much thirst; pupils slightly dilated. 3rd. – 9 a. m., pupils widely dilated and eyes feel cool; some pain in left side of throat on swallowing, as of a splinter there, worst on empty deglutition; throat feels dry and sticky, as also mouth and tongue, but there is no much desire for water; eyes feel tired; slight pain in eyeball, just beneath brow. 10 p. m., pulse 67; dull feeling in head, as if after interrupted sleep; somewhat dizzy. 4th. – Pulse 62; eyes still feel tired, and ache when reading; can read better, and print looks blacker, at double the usual distance; not much headache, but pain (sharp) in upper eyeball is increasing. Took 20 dr. once, and afterwards 10 dr. each hours to 2 p. m., when he was obliged to leave off on account of complete paralysis of accommodation; could not bear to read at any distance, and could not look at food, while eating, on account of pain; felt restless and uneasy all p. m.; slight tremor passed over him several times; pressing pain in eye, and smarting sharp pain under brow; left ear feels as if it had water in it, a dull feeling. 7:30 p. m., bad taste in mouth all d. Retired about 10, and shortly after had the sharp eyeball pain for 20 m. 5th. – A.m., aching in right ear for 30 m. (has not had earache for 10 years); 6:30 p. m., took 20 dr. each hours till 10:45; eyes felt cool during evening; some dry feeling in throat. 6th. – Aching in left ear son after rising; pulse 68; head heavy and dizzy; pain, chiefly over eyes; cannot make out print within 2 feet, and it shows several colours – blue, orange, and reddish – brown, as does the ink when writing; pupils to – day nearly normal, but he could not read or look at print – a plus 20 glass makes vision at normal distance possible, but eyes feel strained in using it; some nausea all p. m.; headache over eyes, and in forehead and temples; smarting sharp pain down right side of face.1 b. This day eyes were examined with ophthalmoscope. O. D., optic disc very red, small vessels visible, large vessels much enlarged and tortuous; outline of disc indistinct; retinal veins dilated, arteries diminished; whole fundus hyperaemic; at time of examination pupils of normal size, contracting under strong list. O. S., hyperaemia much greater; disc intensely red; outlines indistinct; accommodation at time paralysed, could not read No. 1 J. at any distance, but with plus 36 could read it at 12 in., any change in distance causing blur; tension normal.
1 c. On 13th awoke from sleep with throat trouble, resembling that experienced while making proving – dry, burning sensation, with cough. Took 3 dr. of 1st cent., and remained up studying for an hours, when head felt so bad that he went to bed again. The following symptoms were noted: Things seemed elevated; every time he looked up from his book a dull pain through upper part of eyeballs and forehead, like sick headache; eyes felt very large and protruding. (Trans. of Amer. Hom. Ophth. and Otol. Soc., 1879.)
2. a. A. B. N. Usual health; pulse normal (78). April 29th, 8 a. m., began taking 3x dil., 10 dr. every h. P. m., violent cough began and steadily increased (have always had a cough, but nothing so severe as this). 30th. – A.m., hard, dry, hacking cough, caused by tickling at about bifurcation of the trachea; cough causes feeling of soreness or rawness over whole of both lungs, especially lower lobe of left and upper lobe of r. Cough not aggravated or relieved by anything. P. m., great dryness of mouth and throat, especially of lips, only temporarily relieved by water, although he was constantly thirsty for large quantities often repeated. May 1st, evening, pupils widely dilated; cough increasing all day; dryness in throat excessive, especially in back part. 2nd. – Stopped taking drug until noon, and cough grew rapidly better all m., although soreness and rawness of chest remained on coughing; voice began to be hoarse. 1 p. m., began taking drug again; pupils, which had become nearly normal, soon became dilated, and marked dryness of mouth and throat returned, with addition of a feeling as if nose was stuffed up. 3rd. Pulse 63, strong, full and regular; pupils dilated; feeling as if right hand and fingers were going to sleep. 4th. Soreness of right knee below patella, as if strained or rheumatic; lasted all d.
2 b. 6th. – Commenced last n. taking 5 dr. of 1st cent. every hours; was obliged last evening to stop reading, as print was blurred and letters ran together; this continues to – day; was very restless last n., could not get to sleep for hours, had to get up for water every 5 m.; some agglutination of lids this m.; pupils dilated; pulse 62 and intermits about every 8 beats; face much congested; palpebral orifices contracted, eyes feel hot and dry, also face; lids slightly oedematous; slight frontal headache, especially over left eye; tired, hot feeling of eyes, as if over – worked. P. M., has been unable to concentrate his thoughts on any subject; very absent – minded; thoughts wan from one subject to another, but all thoughts are silly and nonsensical; on attempting to walk he stumbled; seemed to have lost control of his limbs; a deadly ” gone ” feeling in stomach, as if at greater curvature, all afternoon, not relieved by eating or drinking; during this time pulse feeble and somewhat intermittent; still has great difficulty in swallowing, especially in empty deglutition; voice hoarse; dilatation of pupils seems to grow less as paralysis of accommodation increases. E., pulse 68; have had a general weakness all afternoon; noticed to – day some increase in the amount of urine passed; loss of memory.
2 c. This day eyes were examined with ophthalmoscope, and throat with laryngoscope. Eyes were found as with C. E. J., but affected in less degree. Following is report of examination of throat. Symptoms subjective. – Voice hoarse; phonation difficult; constant desire to clear throat, efforts to do so generally unsuccessful; sensation of intense dryness, which is partially relieved by lemon juice. Symptoms objective. Inspection. – Pharynx excessively dry and hyperaemic; colour purple red; capillaries very much engorged, presenting here and there varicosities; no secretion of any description visible; in consequence of the unusual degree of dryness, the follicles are very prominent, and the configuration of spinal column readily distinguishable. An almost perfect picture of the so – called ” pharyngitis sicca.” Laryngoscopic examination. – Epiglottis hyperaemic to an unusual degree, particularly in vicinity of glosso – epiglottidean folds. Membrane lining the entire laryngeal cavity intensely engorged, excessively dry, and covered here and there with patches of mucus, viscid, semi – translucent, and closely adherent, presenting the appearance of a pseudo – membrane. The localities where the hyperaemia was particularly great were along the course of the ary – epiglottidean folds; the membrane covering the cartilages of Wrisberg; the capitula Santorini, and the inter – arytenoideal commissure. In was in these last – mentioned localities that the largest proportion of the dry, translucent discharge was seen. Both vocal cords congested, and excessively so as they approached the posterior commissure. Particles of mucus adhered closely to their free borders, forming narrow bands that stretched from side to side when the cords were widely separated in deep inspiration. (A second examination was made, on the 14th, 4 hours after the first dose of D. The same objective and subjective symptoms obtained as before, except that the condition of the secretion was reversed, the pharynx being covered with the partially translucent, closely adherent mucus, yellowish white in character, in detached patches, instead of the larynx.)
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.