3. E. R. -, aet. 30, was noticed about an hour after a dose of Chl. to be much flushed and to present over her whole body a diffuse inflammatory redness, so closely resembling the smooth eruption of scarlet fever that it was thought prudent to isolate her in the hospital for contagious diseases. When these characteristic symptoms developed, a number of long pale elevations or wheals showed themselves in the legs, shoulders and waist, while similar ones could be produced on other parts of the body by scratching. At the same time burning, stinging sensations and a feeling of tightness and hardness over whole surface were complained of, along with wheezing respiration, sharp pains in the eyeballs, headache and lassitude. (Ibid )
4. M. A. -, subject to periodic attacks of mania, entered on one of her wonted paroxysms on March 1st, 1870, and was ordered 20 gr. of chl. ter die. this produced sleep and cutaneous anaesthesia, and on March 4th an unexpected result, in the form of a bright red blush, erythematous in aspect but permanent under pressure, over the chest and shoulders. The blush had on the 6th pervaded the entire trunk and limbs, and had become mottled with livid patches and deep red spots. the lips and buccal mucous membrane had contemporaneously become red and raw looking, the gums spongy and the tongue blistered and ulcerated in several parts. The breath was fetid, pulse 120, feeble and compressible. On March 11th the symptoms began to abate. On the 15th a sort of general desquamation had set in, followed by convalescence. ( Ibid).
5. Woman, aet. 46, labouring under heart disease left hemiplegia, and dementia with excitement, took 15 gr. ter die. from Feb. 24th to March 15th, when numerous reddish-purple blotches appeared round left elbow, on following day enlarging and uniting with others on shoulder and forearm. Next day dull purple spots and discolorations were seen on legs abdomen and back, being restricted in last named situation to a band 2 in. in breadth along each side of vertebral column. There was great prostration of strength, tendency to somnolence, weakness and irritability of pulse, raw state of lips, which were entirely denuded of epithelium, and fissured and thickly coated tongue. On 19th spots had spread in every direction, and had lost their vividness of hue, having assumed a deep purple tinge. symptoms of pulmonary congestion also appeared. Strength gradually ebbed, and after several attacks of syncope death took place on 22nd. (Ibid) [*”The symptoms which these cases presented were of an unique kind, and almost unparalleled in asylum practice at the present day.”*]
6. a. Dr. LUDWIG KIRN reports cases of chronic poisoning by chl. A lady, prostrated by long suffering, had of late experienced attacks of severe dyspnoea, which had increased to asphyxia; at the same time the face was swollen, the facial muscles paralysed, and there were also signs of cerebral effusion. Every remedy had failed, and the patient seemed on the brink of the grave. The consulting physician ordered the daily dose of 45 gr. of chl. to be stopped, and the symptoms vanished is an almost magical manner the respiration becoming normal and the cerebral disturbance ceasing. the dyspnoea may be anatomically explained by its analogy with the effects of Chl. on the skin and mucous membrane, hyperaemia of the lungs being produced through the vasomotor nerves. This confirms the assumption that chl. operates upon the vaso-motor centre and the medulla oblongata, and that is paralysing influence extends thence to the peripheral branches of the affected nerves.
6 b. The same author reports a case of blood-poisoning produced by Chl. in nightly doses of 45 to 75 gr. over a period of 10 weeks. A young, strong, previously healthy person, suffering from uncomplicated mania, developed in 9 days a rash in groups of red spots which soon became confluent. On 20th d temperature and pulse rapidly rose to febrile pitch. 3 days later temperature had reached 106.7; large and repeated doses of quinine were given without effect, and baths only temporarily relieved. Oedematous swelling of face, cheeks, eyelids and ears now set in. During the whole course of the disease the skin did not resume its natural condition but was the seat of now impetiginous, now moist, now scaly eczema, and now ichthyosis, so that desquamation occupied many weeks, during which great sheaths of epidermis were cast off from all parts of the body. there was shedding of the hair and a gradual falling off of all the nails. At the same time the mucous membranes were affected, first of the intestines, causing watery diarrhoea, and then those of the conjunctivae and bronchi. From the 6th week onwards a series of large abscesses formed on both arms, over the shoulders, and within the armpits, which secreted considerable quantities of pus. there was for 8 weeks continuous fever, occasionally remitting. this patient was thus continuously dosed with Chl. when it first came out, and it was not credited with producing severe constitutional symptoms. (Practitioner, x, 361.)
7. A child, aet. 8, was given 5 gr. ter die for whooping – cough. After a few days an eruption appeared on arms, legs and face, and subsequently over whole body, in large blotches of different shapes raised above surface, and of a deep red colour. the conjunctivae were injected, and the face had a puffed, swelled appearance, especially below the eyes. Gradually these blotches coalesced till the whole skin was in this red blotchy state, more nearly resembling measles than anything else. There was high fever, thirst, coated tongue, and loss of appetite, with intense irritation and itching of the skin, preventing sleep at n. (DYCE BROWN, Monthly Hom. Rev., xv, 348.)
8. A stout, middle-aged woman was given 25 gr. in syrup, and after taking it was severely attacked with urticaria. later, 10 gr. were given with same result. (S. W.FISHER, M. D., Brit. Medorrhinum Journ., 1871, i, 331.) [* See also DYCE BROWN, in M.H.Rev., xv, 349; and LEWIN, op. cit., p.170,
9. Feb. 9th, 1870, J. S. – was admitted, suffering from slight anasarca and bronchitis, connected with chronic Bright’s disease. He was restless and nervous, and unable to sleep, and was ordered 30 gr. of chl. at bedtime. Soon after taking it he jumped up in bed, clutched at his heart, and complained that medicine produced a sense of burning. In a few m. he became violently delirious, and after this had subsided was so much depressed that heart’s action could with difficulty be sustained. Gradually pulse returned, and in a few hours he was out of danger. (On theory that an alkaline state of stomach might have converted Chl. into chloroform, a second dose was given later in combination with an acid, but same results followed.) (FULLER, Lancet, March 25th, 1871.)
10. a young lady, in fair health, but restless and nervous, was given 30 gr. at 10 p. m. Almost immediately she became much excited, and complained of pain in chest. In about an hours excitement passed off, and she fell asleep and slept heavily all n. In m., still sleeping heavily and looking very pale, her medical attendant was summoned, and found deep sighing respiration, no pulse at wrist extremities rather cold. It was impossible to rouse her in the slightest degree. Stimulants and warmth had little effect. Dr. Fuller saw her at 2 p. m. and found her in same state. Skin was dry; pulse scarcely perceptible, but heart beat regularly though feebly (120), Muscular system normal, and swallowing power intact. In spite of strongest stimulation she died at 9 next m., never having exhibited slightest consciousness or moved a muscle from time she first fell asleep. (Ibid) [* Dr.Crichton Browne says that Chl. in fatal doses acts by paralysing the heart through the inhibitory nerves. Like chloroform, it appears to have the power of reducing the natural force of action of the heart, and sometimes of stopping its play. Facts are not wanting to indicate that it exerts this power through the sympathetic system, operating through the inferior cervical ganglion. He relates several cases in which the post- mortem signs resembles closely those caused by chloroform. (Loc. cit.)*]
11. a. The Committee appointed by the Clinical Society to investigate the morbid effects of prolonged and continuous use of Chl. reported that over 70 replies had been received out of 1000 applications; 29 stated that no ill effects had been observed. The other correspondents found morbid effects. Cerebral anaemia (Fothergill) with melancholia and impaired mental power; muscular prostration, more especially affecting the legs, causing staggering and debility, almost amounting to paraplegia, and believed to be spinal in origin. With this are occasionally associated peculiar pains encircling the joints above and below, with great dryness of skin (Anstie), and several observes have noticed a singular affection of the fingers, consisting of erythematous inflammation, followed by desquamation of cuticle, superficial ulceration about edges of the nails, with great pain and tenderness to touch (Pf of. smith, of Baltimore.). Cardiac debility is alleged to follow in some cases the prolonged use of chl.; and pharyngeal congestion, with a universally diffused red rash, resembling that of scarlet fever. Other skin affections are also recorded assuming the form of spots of roseola coalescing to form patches of erythema, or of deep flushing of the face and head following these of stimulants (Crichton Browne and Kirn), or petechial and purpuric eruptions may appear (Cholmeley), and may even run into a species of pyaemic condition, in which the ulceration of the gums and great prostration simulate scurvy closely, abscess and deep ulceration of the skin supervening, and even leading to a fatal result.
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.