4 b. When the disease assumes a chronic form it exhibits the following characteristics: – The backs of feet and toes, the dorsum of the hands and fingers (between, not over, the joints), exhibit a peculiar honeycombed appearance of the skin, which is elevated, thickened, and inelastic, so as to hinder flexion. These patches are of natural colour, and not inflamed (except where an isolated papule exhibits the appearance described under the acute form); they consist of densely grouped arrays of hair – follicles, with indurated cutis between and around them, the follicles packed with dry, brittle accumulations of epithelial scales, so extensive as to be easily visible through the dilated mouths of the follicles – these being large enough to admit the extremity of an ordinary probe. The hairs themselves have disappeared from these patches, having probably become atrophic from the pressure of the epidermic masses, while cracks and bleeding fissures traverse the indurated parts, and in rare instances a follicular abscess gives variety to the picture. Knuckles, palms and soles remain unaffected. In the subjects of the chronic malady the complexion is pale and the tongue foul, while the loss of flesh betrays the effect of the sleepless nights caused by the constant irritation and pain of the skin of the affected extremities. (Edinb. Medorrhinum Journ., xvii, 554.)
5. In 1886 I was consulted by a man who had formerly been employed in a factory where much paraffin was used. (He suffered from an inveterate eczema, and found that this was greatly improved whilst working with P.) He told me that the vapour had a singular effect, making some of the workmen insane. They can see things that are actually not visible; for instance, they will see the rails in a station whilst a train is on them. They desire to kill people. Boys (who are much affected). will jump at a straight wall and try to scramble up it. (Clarke, Hom. World, July, 1891.)
6. G. M -, aet. 2 1/2, suffering from rickets, and having a penchant for drinking everything that came in his way, had imbibed some paraffin. An emetic and a purge had got rid of a good deal of it, but when he was brought to me a month afterwards he had, in addition to his rickets and a cough, bad appetite; pallor, with dark rings round eyes; every now and then seems to collapse, goes into a corner, and keeps quiet, will not play. He was quite bright in evening; had cold sweat in bed, complaining of burning fever, and then going cold and clammy. I gave him phosph. 2, and in three weeks he had lost pallor and dark rings, and had ceased to mope, but had come out all over small boils, which discharge, the matter having the odour of paraffin. ( Ibid.)
7. In America, ” paraffin oil ” is used by women in washing linen, a tablespoonful being put into a bucketful of water, as it makes the linen of a better colour. Dr. Bliem has seen cases in which this practice has been attended with unpleasant consequences to the laundresses. One of them experienced the following symptoms: – Severe occipital headache, loss of strength, emaciation, diarrhoea, dyspepsia characterised by fulness on slight eating, accumulation of gas, and very severe attacks of suffocation, finally relieved by eructations of gas. ( Southern Journ. of Hom., July, 1890.)
PHOSPHORUS (See vol.iii, p 553)
II. 34. a. While taking the out – patient department of the Cardiff Infirmary for Mr. Griffiths on Sept. 14th, 1889, H. D – -, a servant maid, aged 15, came as a patient. She complained of pains all over her, great headache, vomiting of blood twice, faintness and great languor, unquenchable thirst, and inability to take any food. A week previously she had been in perfect health. The illness began on Sept. 7th with headache and faintness. Pains in the back had next become the most intense symptom. On the 13th she had vomited a pint of blood, ” dark thick stuff.” The next day she had again vomited one or two ounces of blood. On the 13th she noticed she had become yellow. Her bowels throughout had been very costive. On examination I found that the patient showed extreme prostration; her cheeks were brightly flushed, the tongue dry and black, and the breath extremely offensive. The pulse was 120, weak, thready, quick, and very compressible. Thinking the case was one of some acute specific fever probably, I took the temperature and was surprised to find it 98.5 o. The girl was plump and well nourished; there was well – marked jaundice of face and body. The heart and lungs were normal. The whole of the abdomen was very tender to palpation. The liver dulness was diminished, and the liver area very tender. From the above symptoms, and especially from the history of sudden onset, and the normal temperature, I came to the conclusion that the case was one of acute yellow atrophy, or phosphorus poisoning. On cross – examination she could recall having taken nothing injurious or poisonous of any kind; and after beating about with non – leading questions in vain, I asked her whether she had had any rat poison in her possession before her illness. She at once answered, as if it were quite a new idea to her as connected with her as connected with her illness, that she had had some, which her mistress had given her to spread for rats. She stated most positively she had taken none, and had not touched it except with a knife, with which she spread it on bread. However, the admission of possession seemed sufficient, and I admitted her on the phosphorus – poisoning diagnosis. She passed into a condition of come the same evening, and after renewed haematemesis died at 7 a. m. next m. Her urine was secured previously, and found to be very highly coloured, with a deposit of epithelial cells like bladder – cells; free from albumen; it gave most brilliantly the crimson reaction with mercurous nitrate typical of tyrosin, and on evaporation showed numberless sheaths of fine tyrosin needles and transparent glassy plates of leucin. Besides these, there were numerous hedgehog balls of coloured acicular crystals looking like uric acid.
34 b. The necropsy was made by Mr. Thomas, house surgeon, 30 hours after death. The weather was warm. The rigidity was marked. The body was plump and well formed, but generally jaundiced. There were no petechiae. A liquid like coffee – ground stuff streamed from the nose. On opening the abdomen the liver was found to be shrunk out of sight beneath the ribs. The bowels were distended and darkly stained. The pericardium contained two ounces of straw – coloured fluid. The left side of the heart was contracted, and the right flaccid; there were no clots. The tissue was friable and stained yellow. The lungs were slightly congested. The stomach contained about two ounces of ” coffee – ground stuff.” The mucous membrane was stained black on the top of the rugae, and was very thick, soft and friable all over. The intestines were full of ” coffee – ground stuff ” in the ileum and jejunum. The mucous membrane was in the same condition as that of the stomach. The large intestine was full of black – stained soft faeces. The liver was small in size and solid in consistence; it weighed 45 1/2 oz. The capsule was adherent and thickened. The gall – bladder was empty. In the middle of the under surface of the right lobe was a natural fissure half dividing it into two lobes. The surface was of a uniform, bright chrome – yellow colour. On section it was found to be soft, intensely yellow, friable, greasy to the touch, and showing the lobules clearly marked out with fatty and congested areas. The liver resembled, when broken, yellow faeces more nearly than anything else. The cortex of the kidneys was very pale, soft, and friable; pyramids congested; capsule normal. The spleen was of normal size, pale and diffluent. On opening the skull Mr. Thomas detected a distinct smell of phosphorus, and on making sections into the brain this was apparent to all in the room. The brain was otherwise normal. No luminosity could be obtained from the organs.
In the inquest held on the case the most interesting fact was obtained that the girl had been giving a ” dark seance ” to other girls, and had rubbed the paste into her hands and face to produce blue flame, just before the onset of illness. She denied to me most positively having taken any by the mouth; and though she told me nothing of the seance she had said that she felt bad first after spreading the paste for rats. Probably she was ashamed of the seance, and had really felt bad after anointing herself for this. The question therefore arises whether death could occur from inunction of rat paste, which seems probable here. There is no case on record, I believe, of such a death. Could she have rubbed the paste on her teeth and tongue, to emit blue flame possibly? From the severity of symptoms it looks as if much poison had been absorbed. There was no cause for suspecting suicide; the hymen was intact, and the uterus appeared to be just menstruating, a Graafian follicle having just ruptured in the left ovary, and her whole bearing was utterly unlike a suicide. Another point of interest in the case is the fact that the poison could be diagnosed from the symptoms alone. Had I been a believer in acute yellow atrophy as a disease apart from phosphorus poisoning, I should probably have put down the case to that; but believing the two to be one and the same thing, I was sufficiently pertinacious in my cross – examination to hit on the right track, and to prove the necessary possession of phosphorus. The patient died in the usual time, on the 8th day after initial symptoms. (Hill, Lancet, 1890, i, 398.)
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.