18 b. A child of 4 entered the hospital for a violent ulcero – membranous stomatitis. A solution of 15 grm. of K. chl. was prescribed, of which at least two thirds were taken in a day. Nest day there was torpor, cadaverous paleness, strong beat of heart, pulse 100 and scarcely perceptible. There was diarrhoea like that of typhoid, and vomiting of liquid mucosities. On the following days, there was delirium, jactitation, haematuria, epistaxis. Then, by degrees, the general condition improved; but the child was ailing for a fortnight. The urine, examined with the microscope, contained a copious sediment composed mainly of elongated, brownish, cylindrical masses.
18 c. A child of 3, under treatment for pultaceous sore throat, took 12 grm. of K. chl. in 36 h. The day after, an emission of dark – brown urine, manifestly sanguinolent, was observed, and thereupon came vomiting and cerebral disorder – phenomena which persisted for some day more. Three day after the commencement, Dr. Marchand saw patient for first time, and found her in a completely stupid state, without fever or dyspnoea, responding with difficulty to questions; skin was yellowish; all food was immediately rejected; a little epigastric sensibility. Thanks to tepid effusions, iced drinks, champagne, &c., the vomitings at length ceased; but the child continued restless, ground her teeth, and lost consciousness more and more. The general state by end of 8th day was exactly that of acute hydrocephalus. To the other symptoms was added convulsions, inequality of pupils, Cheyne – Stokes breathing, and at length stiffness of neck and opisthotonos. She died on the 10th d. The sanguineous urine had contained albumin and a great number of altered blood – corpuscles, arranged in brown cylinders as in previous case. The spectroscope showed neither the lines of haemoglobin nor those of haematin; and yet the colour of the urine was that of a solution of haematin. At the autopsy, the blood was found liquid, without special coloration. There were no appreciable lesions in the brain. The kidneys were profoundly altered, at any rate in the medullary portion, which contained a great number of small miliary agglomerations of lymphoid cells. All, the pyramidal canals were stuffed with the brown cylinders.
18 d. A child of 6 – 7 was treated for slight croup with 25 grm. of K. chl. in 30 h. Vomitings and bloody urine ensued, followed by rapid collapse and death in a few d. There was no autopsy.
19 e. A syphilitic, with a mania for treating himself, at last took K. chl., and died suddenly. At the autopsy, there was yellowish hue of skin, petechiae, and haemorrhagic effusions into the subcutaneous cellular tissue. Kidneys were hypertrophied; surface smooth, chocolate – brown in colour, studded with numerous points of dark brown; cortex very thick, of same colour as surface; medullary substance of a still darker brown with a manifest brownish striation, directed towards the pyramids. Under the microscope the excretory canals were found charged with brilliant brown cylinders evidently composed of matters derived from the blood.
Experiments on animals
1. a. The question, wherein lies the poisonous action of K. chl., is answered by the results of experiments made by Felix Marchand upon animals, whose attention was first called to the subject by meeting several cases of poisoning. If fresh blood is mixed with a solution of chlorates of potash and sodium, there appear after a short time peculiar changes. The well – known bright – red colour of the blood, which it instantly takes when mixed with a salt or kali solution, passes in a few hours into a dark reddish – brown, and this gradually into a clear brown. The time at which the last change takes place depends upon the quantity of the salts which is added. A 1 per cent. solution of the salt gives rise, after 15 to 17 hours, to a considerable colour, and a 4 per cent. solution destroys, after 4 hours, all traces of the haematoglobulin (at 50 o R.). Very soon this sample takes a syrupy consistency, which by the addition of a 2.5 per cent. solution of the salt passes in a short time into an almost solid gelatinous form. This mass has a remarkable durability and appears unchanged for weeks, especially in relation to putrefaction. In order to determine these conditions upon living animals, Marchand fed daily, for one week, a dog which weighed 17 kilogr. with 5 grm. of sodium chlorate, and when this produced no effect, he increased it to 10 grm., given in two doses; still the dog remained to all appearance in perfect health. He then gave 50 gr. in five doses; on the following midnight the dog was dead. On examination the entire quantity of the blood was found to be of a watery consistency and of a dark chocolate or sepia – brown colour, which did not change upon exposure to the light. All the organs had a peculiar blackish – brown appearance. The lungs were of a smoky – gray, and the heart – muscle of a dark brown colour; spleen greatly enlarged. The kidneys were enlarged, altered, and the capsules smooth and of a dark chocolate – brown colour; the body of the kidney was found, on section, to be of the same blackish – brown colour as the surface, and of solid consistency. The bladder was contracted and contained about a teaspoonful of a thick, brownish fluid; also a crumbling, brownish – red coagulum, about the size of a bean. A microscopic examination of the kidney showed in most of the tubuli uriniferi, especially in the cortical substance, a transparent, homogeneous, brownish cylinder, also numerous cylindrical masses, formed apparently out of aggregated blood corpuscles. The epithelium of these rubes appeared thickened, especially in the cortical substance, and the corpuscles were in masses. The brownish fluid in the bladder contained granules in active molecular motion. A spectroscopic examination of the diluted blood showed the haematin line with a clear stripe in the centre. A still weaker solution failed to show the haematin stripe, but the lighter stripe remained. The diluted blood remained still of the coffee – brown colour when held to the light, and did not become red on shaking, but formed a brownish – white foam, like beer.1 b. In order to obtain an earlier stage of the kidney affection he took a dog weighing from 7 to 8 kilogrs., and within 16 hours gave 15 grm. of chlorate of potash in three equal doses; 7 to 8 hours after the last dose the dog was bled to death. The blood from the artery femoral was of a markedly dark, brown – red colour, which did not redden in the light and in the spectroscope showed a weak tracing of the capillary haemoglobulin streak. Both kidneys were of a pale brownish colour and showed on section several cuneated but small radiated dark brown spots and stripes, which began under the capsules and gradually disappeared in the cortical substance. The bladder was very much distended with a dark brown (more correctly a greenish – brown), thick urine, which was mingled with a very abundant slimy white precipitate, which undoubtedly had prevented the emptying of the bladder. The spleen was greatly swollen, reaching across to the right side of the body; the capsule was smooth, polished, blackish – brown; the whole pulp homogeneous, quite solid, and of a very dark, blackish – red colour. The other organs had a peculiar dark, brownish – red colour.
1 c. According to these experiments and from observations upon men, there can be no doubt that chlorate of potash (and soda) in large doses may produce death, through a peculiar and most remarkable alteration of the blood, especially the blood – corpuscles and the haematin, while the alteration of the spleen, kidneys and urine follows as a secondary result. The blood loses its power to take up oxygen; the haematoglobulin is decomposed and the corpuscles disorganised; these are accumulated in different organs, such as the spleen, kidney, and marrow of the bones, to be finally completely destroyed, and pass through the kidney to be excreted, during which the epithelium of the urinary canals is but little or not at all altered; and if the quantity of disorganised blood – corpuscles is great enough, death follows. (Virchow’s Archiv, lxxvii, 455.)
KALI CYANATUM (see vol. i, pp.31, 35; ii, p.724)
II. 27. a. A photographer, aet. 24, took with suicidal intent an unknown quantity about 9 a. m. His neighbours, hearing a fall, entered his room and found him stretched on the ground unconscious. After having vomited some fluid matter, he was taken to the hospital. At 10 he was in profound coma; skin cold, covered with viscid sweat; coldness of extremities; intense cyanosis of face; eyes protruding, turned upwards and outwards, not covered by lids; considerable dilation and absolute immobility of pupils; flow from mouth of a spumo-sanguinolent saliva; breath smelling strongly of prussic acid. Trismus was marked; there were disseminated ecchymoses in bucco-pharyngeal cavity, and a whitish eschar on the right side of the vault and veil of the palate; tongue was drawn back over glottis. Limbs were in complete resolution; there was entire loss of sensibility and reflex excitability. Breathing was very slow, deep, convulsive, and presenting somewhat prolonged pauses; a tracheal rale was perceptible both in respiratory acts and in pauses. Pulse was very small, 120, and at times intermittent. Sonorous rales were disseminated throughout chest. Cardiac impulse imperceptible; heart – sounds distinct, but dull and irregular. Temp. 36.2 only. Involuntary micturition. Zss of sulphuric ether was injected subcutaneously, and stomach then washed out till the water had no longer the odour of bitter almonds. Patient’s condition, however, rapidly became worse, resp. growing more irregular and pulse smaller notwithstanding repeated injections of ether. He was then placed in a hot bath, and iced water was poured over head and nape. Every time water was poured on head, patient drew deep inspirations; gradually breathing became deeper and more regular, and all dangerous symptoms had disappeared after an h. At 7 p. m. patient had completely regained consciousness; and complained of sharp occipital and gastric pains. Convalescence was rapid; but a general muscular weakness and impairment of speech lasted for a long time. (Muller – Warneck, Berl. Kl. Wochenschrift, Feb. 4th, 1878.)
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.