28. In the ” Reports on the Progress of Medicine ” in the New York Medical Journal for Aug., 1878, is a notice of several cases, in which, after the administration of quinine in moderate doses, a profuse exanthem appeared which lasted several days, and was followed by desquamation lasting from two to three weeks. Two of the cases were observed by Prof. Koebner, of Breslau. In one case there was a repetition of the phenomenon after a repetition of the dose. Dr. Ricklin, who reports the cases in the Gazette Medicale, was able to discover only four analogous cases in medical literature. But the ” Report ” states that Dr. Pflueger, of Berne, found the eruption to appear after the administration of the decoction of cinchona as well as after sulphate of quinine. In one of the cases the eruption resembled urticaria, but in this case the desquamation lasted three weeks. In all the cases the general symptoms were severe and even alarming; in one, that of a physician who took a gramme of quinine for facial neuralgia, ” there was intense fever, delirium, dyspnoea, and all the signs of pulmonary congestion.” Dr. Ricklin considers these cases important, ” especially in view of the large number of pretended relapses of febrile exanthemata, particularly of scarlatina, which have lately been recorded.” Serious symptoms following the use of quinine are so rare (though not infrequently alleged by non – professional persons, especially those under the care of homoeopathic physicians) that the writer deems it of sufficient interest in this connection to refer to a few cases which came under his own observation a few years ago while practicing in Cold Spring. 28 a. A delicate laundress in the employ of a neighbour of the writer required a tonic, and when he proposed quinine she stated that it had produced dangerous symptoms when administered on a former occasion. One of the ordinary elixirs of calisaya was accordingly prescribed, and in a diminished dose. On his return home after an absence of some hours, his associate, Dr. G. W. Murdock, informed him that the first dose produced very unpleasant symptoms, and that, after the second, he was summoned and found her in a comatose state, with cold extremities, hot head, and symptoms of cerebral congestion. He combated these alarming manifestations with vigorous measures, including cupping of the temples, hot stimulating pediluvia, &c., and was obliged to remain with her before she was out of danger. She afterwards informed the writer that a sister had been similar, but not so seriously affected by a small dose of quinine.
28 b. Soon after this occurrence, the writer prescribed a moderate dose of quinine for a female domestic in the family of a gentleman boarding at Garrison’s. He then proceeded to West Point, and some hours after, on his return, met a messenger who had been sent to find him with the message that the girl had been taken suddenly very ill. He found her recovering from the attack, which had presented symptoms similar to those above narrated, but in a much milder degree.
28 c. A lady patient of the writer’s in the same neighbourhood informed him that quinine always weakened instead of strengthening her. He tried the experiment with small doses without her suspecting it, but she soon detected it by the peculiar prostration which it produced. He then tried the citrate of iron and quinine, but even this was detected in the same manner. At about the same time a case occurred in the practice of a medical acquaintance on Staten Island. A lady patient informed him, when he proposed to administer quinine, that it had always produced alarming symptoms; he, however, rather ridiculed the idea, and said he would give her a small dose and remain with her to observe its effect. He did so, and soon had reason to regret his experiment, as he was himself alarmed at the symptoms. What they were the writer did not learn, as the case was related to him by a friend of the patient, (Leube, N. Y. Medorrhinum Record., Nov. 16, 1878.) 29. Dr. Rosenbusch, of Lemberg, reports a recent case of acute quinine poisoning which he had observed in the hospital of that city. After the administration of 1 grm., patient was attacked with shivering, tinnitus aurium, severe headache, coldness and pains in extremities, palpitations, and vomiting, with great prostration. An hours later he became unconscious, temp. (which had never before exceeded 28.7 o) rose to 39.7 o; pulse was 158 and compressible; pupils contracted but reacting to light; tongue dry. Skin of face and whole body presented a uniform redness resembling that of scarlet fever. Resp. was difficult. Castor oil, caffein, and cold compresses to head and heart were ordered. On following day temp. was only 36.5 o; pulse 108, with considerable arterial tension. Patient had had a restless n., and with delirium; bowels had acted towards m.; rash was paler, pupils had regained their normal size, and tongue was red and coated with yellow patches. Sensations of tearing and trembling in extremities were complained of. Bromide of sodium was given. Rash and other symptoms disappeared in 2 day, and only a slight pigmentation of skin remained. (Patient stated that 5 years previously he had a similar attack after taking two 1/2 grm. powders. On that occasion rash disappeared the following d.) ( Brit. Medorrhinum Journ., May 5th, 1888.)
CHININUM ARSENICOSUM
I. 3. H. L. Northrop, aet. 21, tendency to itching eruptions of skin. 1st day, took 1 gr. of 1x trit. 2 hours after breakfast, soon followed by itching on neck and scalp lasting 40 m. 1:20 p. m., sharp pain in head, beginning in left frontal region, shooting towards occiput, and followed by dull sore feeling along track of pain, lasting several m. Itching again on head and sole of left foot. 1:40, intense tired feeling in left side over middle and lower rib, like side ache, lasting from 15 to 20 m. 4:10, dull heavy pain in left side of head while sitting, relieved by walking. Pulse slow and irregular. 5.5, itching, relieved by scratching and then reappearing elsewhere. At 5:20, while bathing, itching of almost entire body; when using towel felt sore spot over triceps of right arm. In m. nearly whole of cutaneous surface over triceps was bright red, somewhat swollen, and had a burning tender feeling like sun – burn. 5:45, intense itching in a small spot on outer side of right leg. 8, dull pain in right lateral half of head, followed by desire for stool which was relieved by passage of much flatus. 11, itching reappeared, aggravated by warmth of bed or bedclothes. 2nd day – 10 a. m., sharp transitory pain in left leg. 2:30 p. m., dull continued rheumatic pain in left shoulder – joint, aggravated by lying on left side. In evening transitory attacks of pain in left shoulder, leaving locality tender. Appetite increased throughout d. Soreness over right triceps continues, causing burning feeling when touched. (Trans. of Amer. Inst. of Hom., 1888, p. 149.)
4. C. W. Benedict took 1 gr. 1x trit. An hours later felt slight dull pain in left temple, occasionally a shooting pain through right temple. This was followed by a dull ache in vertex, lasting an hours, and attended with slight nausea. Slight constipation. Appetite improved; food seemed to taste better than usual. No further effects. (Ibid.) 5. T. L. Macdonald, aet. 27. Took 1 gr. 1x trit. at 6 a. m. 8:30, sudden and violent urging for stool, evacuated with prolonged gush until bowels were empty; stool thin, brown and painless. 10:30, similar stool; less watery. 3 p. m., dull heavy headache, frontal and occipital, continuing until bedtime. 2nd day – Headache of similar kind. In evening, a peculiar burning ache about sphincter vesicae and through urethra. 3rd day – No symptoms. 4th day – Dose repeated; no symptoms. 5th. – Dose repeated at bedtime; was called up at midnight and could not sleep for 3 hours on returning to bed. 7th day – Same dose. Constipation, stool dark and lumpy. Dull heavy ache in cerebellum, worse from slightest motion. 8th day – Less constipated. Dull, stupid feeling in head, lasting from noon until bedtime. 9th day – Four soft stools. Headache slight in m. 10th day – Stool hard again. 11th day – Same dose. Slight cerebellar headache p. m. and evening 12th day – Same dose. Urination more frequent. Slight dull ache in frontal and occipital regions, lasting till noon. Stool very hard, voided with difficulty, aided by pressure of finger on tip of coccyx. 13th day – No symptoms. 14th day – Same dose. Increased micturition and more frequent. 15th day – Bladder had to be emptied during n., having had nocturnal emission (probably from distended bladder). Slight headache in m. No further symptoms. ( Ibid.)
6. a. Milson R. Allen, health good, uses tobacco and coffee in moderation. 1st day – Took 2 gr. of 6x trit. at 10:30 a. m. Woke at 3:40 p. m., after an hours ‘s nap, with feeling of being extremely tired. During evening had dry mouth and much thirst; drank 6 glasses of water 6 11 p. m. 2nd day – Thirst continued up to noon, with exhilarated feeling. At noon severe peculiar feeling about heart, as if a hand suddenly grasped it, and, holding it for a moment, let go; the symptoms recurred for a period of 7 m. 3rd day – Renewal of heart symptoms; no other effect.
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.