20 b. The prolonged use of large doses produces, in many cases, the feature of true poisoning, characterised by three orders of phenomena, nervous, gastric-enteric, or typhus.
The troubles of the nervous system show themselves 1/4-1/2 hours after Ist dose, progressively augmenting towards e. They are “paracousia,” vertigo, amaurosis, intoxication. (1) the patient hear diverse noises, which they compare to those produced by a pendulum or a windmill, by rain, steam, distant bells &c.; most commonly it is dull and continued, like a humming. It is nearly always alike in both ears. It is very troublesome, as impeding hearing; deafness is rarely complete. This “paracousia” precedes other troubles of senses, and persists with great force for 24 hours (2) Vertigo is rarely absent, but varies in intensity. Most feel it only on rising and sitting down, but with others there are such stooping turnings in head that they stagger as if drunk. It is not associated with headache, and one patient who had this trouble constantly ceased to experience it while under the treatment. [*”Severe frontal headache, with dull, heavy, tensive, and sometimes agonizing pains, are some of the most distressing and frequent symptoms that follow a large dose of quinia-gr. xx. Even small doses, in persons very susceptible to the action of the medicine, will produce the headache” (RINGER)*]. The vertigo of Ch. resembles much that of typhoid fever, and may be accompanied (as there) by stupor, habitude, and the peculiar typhoid expression of face. (3) troubles of vision are less marked and constant. Sight is blurred, and object appear as if seen through a cloud, in about one third of the cases. Amaurosis was only observed four times; in one case, though complete, it lasted only 24 hours, and in two a still shorter time; but the fourth, the subject of a local and non-febrile rheumatism, entirely lost her sight, after having taken during 2 day 3 gr. some unusual phenomena, as drowsiness, lively itchings of skin, and a little delirium, led me to think that some morbid predisposition was present here, but these accidents ceased completely after 5 days (4) the quinine intoxication may be characterised by great excitement, or by a prostration and collapse quite typhoid in appearance. In the former case the patient are agitated, seek sometimes to leave their beds, speak with a voice broken, trembling, often indistinct, and affirm that they are quite free from their rheumatic pains, though the redness and swelling of joints persists. The second form is more common; prostration, stupor, great weakness, a certain slowness of intelligence and memory, and a discouragement which leads them to refuse their medicine. At same time eyes are sunken and lids only half open.
20 c. The gastro-enteric symptoms of Ch. are the effects of its local action on the alimentary mucous membrane. They are closely related to those produced by irritant membrane. They are closely related to those produced by irritant poisons. the inflammation seems hardly or slightly to involve the large intestine; and is peculiar in the frequently with which it is accompanied by membraneous formations in the mouth, and by vomiting of free or yellow bile.
20 d. The typhoid symptoms generally supervene upon those of gastroenteritis. In two patients, however, they appeared alone. The first showed a profound alteration in expression, stupor, great prostration, repeated epistaxis, and a number of small but well – characterised ecchymoses on the abdomen. The second had headache, injected conjunctiva, habitude, altered countenance, and a state of prostration and exhaustion as great as in the most severe enteric fevers; the collapse seemed even threatening to life. The ensemble of symptoms presented by these and other patients gave so exact an idea of the typhoid stage, that, had we not known their real cause, we might well have set down these subjects as affected with actual enteric fever.
It thus appears that Ch. produces three orders of toxic phenomena: the first, which quickly follow the administration of the medicine, being due to its absorption and action on the nervous system; the second, slower in production, depending on its direct and prolonged action on the alimentary mucous membrane; the third revealing a general morbid condition of a typical kind, and probably due to some of alteration in the blood. (MONNERET, Journ. de Med., 1844.)
21. Mr. Scott, surgeon, for intestinal neuralgia took quinine 4 times a day, increasing from 2 gr. by 1/2 gr. a day to 20 gr. doses. When the dose amounted to 15 gr. he began to feel heat of skin, dryness of mouth and fauces, and obstinate constipation; at the same time lost power of naming substantives, and was obliged to think for a long time before naming familiar things. the simplest arithmetic became impossible to him. His perception of quantity was impaired, so that in prescriptions he wrote ounces for drachms, ordered liquids to be made into pills, &c. Nevertheless, he continued increasing the dose until he took 20 gr. 4 times a day the symptoms increased and he was often unable to stand and used to fall suddenly in the streets. He discontinued it for a while and on recommencing found that 8 gr. doses now produced the same symptoms. [* A Washington lawyer was guilty of strange escapades. His father writes: “Thinking it a safe thing to do, my son has been in the habit for months or carrying Ch. in his pocket, and taking it in small but frequent doses. The result is an elevated sanguine state of mind, quite beyond the bounds of reason. His memory is not yet impaired, and the marked improvement already consequent upon being deprived of the drug gives his friends reason to expect complete restoration in a short time” (Journ. of Mental and Nervous Diseases, July, 1881 *].(Lond. Medorrhinum and Phys. Journ., 233, 1, 59.).
Experiments on animals.
1. a. In the experiments performed by Majendie, and also by Molier, Ch. given to dogs in 3ss doses acted poisonously and was rejected from the stomach, unless the oesophagus was tied. When this precaution was taken, however, death occurred in about 24 hours, and was preceded by retching, agitation, trembling, and an unsteady gait, with a drooping and feeble aspect. The pupils were dilated, the pulse frequent (120); and coma, with muscular spasms and labored stertorous breathing, preceded death. On dissection, lungs were found engorged with blood; vessels of brain and stomach were congested, and blood contained in them was liquid, or else formed a soft gelatinous clot, and the serum was turbid and discoloured.
1b. On injecting ch. beneath skin of frogs Eulenburg found movements of heart diminished in force and frequency, and respiration, after growing irregular and feeble, ceased; but heart pulsated for some time after breathing was suspended. (STILLE, op. cit.)
2. Eulenburg has also found that the drug in poisonous doses abolishes in frogs all reflex action before voluntary motion. According to the experiments of Chapman, this lessening of reflex action is due, not to a direct influence of ch. upon the cord, but to a stimulation of the inhibitory reflex centres which Setschenow has proved to exist in the cerebrum of the frog; and this result certainly accords with the experimental observation of Euleburg that in quinine poisoning no stage of excitement of reflex action precedes that of the depression of function. (H. C.WOOD, op. cit.)
3. LEWISKY coated a rabbit thickly with wax, and injected C. into veins. In spite of loss of heat being prevented, internal temperature fell almost as rapidly as when no such coating was practiced. Moreover, in latter case internal and external heat underwent parallel depression; while, were loss of heat from surface the cause, it would be otherwise. (L’ Hom. Milit., 1879, p. 155.)
4. Experiments have confirmed in an absolute manner the fact that after suitable dose according to size of animal, death always supervenes with diastolic arrest of heart; and this is cause of death. Cardiac muscle is the first to die in quinine poisoning; it has lost electric contractility while other muscles have retained it. (COLIN, ibid.)
5. Dr. BALDWIN made a series of experiments on animals. The principal symptoms were general restlessness, speedily followed by muscular agitation or tremulous movements of body and extremities, with constant movement of head resembling paralysis agitans. When under full influence of poison power of locomotion and even of standing was lost, extremities being apparently paralysed. Great excitement or vascular system was present, pulse rising from 110 to 160 and even to 240, with great oppression of breathing and frothing at mouth. Pupils much dilated, and, so far as could be judged, vision entirely lost. Convulsions were observed in every case but one. In a few instances, animal seemed as if stunned by a sudden blow or violent fit of apoplexy; this only when drug was administered to young dogs by jugular veins or peritoneum. Purging was present in some cases, and when drug was given by mouth vomiting invariably occurred, unless oesophagus was tied. The time required to produce death varied greatly. In some instances 15 or 20 gr. proved fatal in a short period, in others only in a long period after 120 gr.; peculiar idiosyncrasies, as in the human subject, appearing to favor or retard its action as a poison. The chief post-mortem appearances were a dark, fluid, and defibrinated condition of the blood a congested state of the lungs and brain, and strong vascular injection of stomach and bowels. (Amer. Journ. of Medorrhinum Sci., 1847, p. 292.)
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.