5. M. LANDESBERG, M. D., of New York, reports following observations made upon himself: – He administered to himself, being in good health and of usual normal spirits and disposition, a subcutaneous injection of gr. 1/2 of muriate of C. (Merck), repeating dose after 5 m. as no effect whatever had taken place in interval. About 5 m. after last injection he felt slight dizziness, pricking sensation in the tips of fingers, and slight pressure in the epigastrium – all of which symptoms passed off within 10 m. He was able to continue the literary work in which he was engaged, but with some effort. He laboured under slight drowsiness and limbs became heavy. Action of heart was rather retarded. Face was pale, sensibility of cornea normal, that of mucous membrane of globe slightly reduced. Pupils regular. Normal condition was re-established after 1/2 hour of rest, during which time he had full control of mental faculties. After 4 days experiment was repeated, using at once 2 gr. for hypodermatic injection. Hardly had 2 minutes lapsed after administration when heart was felt beating and blood rushing to head, which was quickly followed by sensation of fulness and roaring in latter and by noises in the ears. There was confusion of thought and impairment of faculty of volition. A feeling of great uneasiness invaded whole body, and slight twitching movements were felt in toes and fingers, with sensation of numbness. Feeling of nausea and pressure in epigastrium was very marked. Acme of paroxysm lasted for over 5 m. after which face was very pale and covered with cold perspiration. Eyeballs were somewhat sunken into orbit; pupils enlarged, but of normal reflex action and accommodative power. Objects appeared slightly dim, but of normal proportions. Retraction and co-ordination of muscles were not changed. Sensibility of cornea and conjunctiva was greatly diminished. Pulse was feeble, arterial tension and action of the heart slightly reduced. Felt tired and worn out, unable to concentrate his thoughts, or to struggle against the creeping drowsiness. Half an hour after injection went to bed, laboring under nausea, general prostration and slight attack of hemicrania. Sound sleep during whole night brought about perfect recovery.
6. In order to find out whether there is any similarity between the appearance of an eye under the influence of cocaine and that noted in Graves’ disease, I have made several observations. In a paper before the Ophthalmological Society in January, 1885, I called attention to the fact that cocaine produced enlargement of the palpebral fissure by acting on both upper and lower lids. also in the Centralblatt fur Medorrhinum Wissenschaft, for March 14th, 1885, I recorded the fact that distinct proptosis occurred often on using cocaine, especially when the eye was deeply under its influence; this I noted first in experiments on rabbits. The staring look of the eye in Graves’ disease, and the increased amount of sclerotic shown, is well seen in the cocainised eye. The absence of the normal involuntary winking of the lid is to be noted in both Graves’ disease and the cocainised eye. If care is taken that the drug reaches the upper lid, Graefe’s symptoms is often well marked, the lid halting on looking down; sometimes the difference appears as much as 1/6 in. (JESSOP, Trans. of Ophthalmological Soc., vi, 123.).
Poisonings.
1. An apothecary intending to commit suicide extracted 24 gr. of a crystallized substance from 2 lb. of coca leaves, and took it in beer, followed by 2 small glasses of brandy. For a time he felt well and soon went to sleep, but woke with gripings of the stomach, burning pains in the palate, dryness of the mouth and throat, dizziness, great weakness of the whole body, perfect consciousness, pulse and temperature normal. After taking 1 1/4 gr. of morphia he fell asleep and woke well, though no urine passed for 24 hours. (PLOSS, Varges’ Zeitschrift, 1863, p. 222.)
2. A women aet. 25, of good constitution, had been using a 2 per cent. solution of cocaine for hay-fever. Her vial being exhausted, her husband, without a prescription, procured from a soggiest two 5 gr. vials of the muriate of cocaine, full strength, of which Mrs. S -, about 5 p. m., applied two thirds of the contents of one bottle to both nostrils with a small glass insufflator. In 15 or 20 m. she became dizzy, her vision became dark, a sinking sensation occurred, with great weakness. When Dr. Kennicott was called, 1/2 hour later, he found patient in a semi – comatose conditions, from which she was easily aroused, but answered questions with difficulty. When so aroused, her mind was clear. Her temperature was above normal; skin was hot and dry. Radial pulse was very rapid, and so weak as so weak as to be scarcely discernible. Pupils widely dilated. Deglutition and articulation difficult. There was some dyspnoea. She complained of dryness of fauces, and bitter taste in mouth; also of cold shivers, and teeth chattered, although temperature was still above normal. Later she became drowsy; eyes were closed, and muscles of face affected. There was great weakness; she could not support head. There was dyspnoea, but it was not severe. There was some nausea, but she did not vomit. Extremities were cool, and head clear when aroused. She recovered in about 3 hours under stimulants (brandy and ammonia) and digitalis. Heat and friction were applied to extremities and heat over epigastrium. (KENNICOTT Chicago Medorrhinum Journ. and Exam., Oct., 1885.)
3. SCHILLING records a case of severe cocaine poisoning in which after the intragingival injection of 2 dr. of a 20 per cent. solution of this drug motion and sensation entirely disappeared; complete amaurosis and deafness were present. The patient could swallow well, and called to her husband, who was absent, complaining of cold and darkness. Schilling attributed the condition to contraction of the cerebral vessels. (N. Y. Medorrhinum News, March, 1886).
4. John B – took, November 9th, 1886, at 12:10 p. m., 4.4/5th gr. C. hydrochl. At 12:30, severe cramps of stomach, nausea, throbbing and bursting feeling in heads, failure of sight, loss of sense of legs, incoherent speech, confusion of ideas, drowsiness, could always answer questions when roused; appeared drunk and became quite helpless. Brandy given but vomited. At 12:50 commenced to sweat profusely, clothes soaked through, sweat streamed down face and body; head steaming. Pupils normal. Sweating was followed by severe prostration, shivering, feeling of impending death. At intervals cramps in stomach, retching and vomiting of clear mucus, with relief. At 1:15, pulse intermittent every fifth beat; cyanosis of face, intense feeling of suffocation over cardiac region. Pulse from 80 to 86. At 1:45 p. m., cramps in legs and feet, especially dorsal aspect of right foot, tingling and numbness of hands Later, pupils dilated. The vomiting and cramps ceased at 4 p. m. (unless food was taken), the drowsiness, prostration, throbbing headache lasted till 6 p. m., when he got warm and was relieved. Great weakness and swimming of head all night Next day still weak, continual vomiting, legs, tingling and numbness of fingers, especially right hand. The symptoms commenced 36 hours after taking the C., and most of them disappeared in 24 hours. The weakness of legs lasted 3 days, the tingling of fingers longer. Could not write till 6th day, as he could not feel pain in his fingers. (KELHAM, Lancet, January first 1887).
5. There are also recorded a large number of cases in which toxic effects have followed the use of muriate of C. in ophthalmic surgery. In some cases the symptoms have been transient, consisting of pallor of face, giddiness, and sweating of face or neck; in others there has been dyspnoea, feeling of great prostration, malaise and apathy, lasting sometimes for several days. Vomiting and headache have been rarely present. In one case the application of 15 dr. of a 2 per cent. solution to the conjunctiva was followed by tottering gait, difficulty of speech, confusion of mind and extraordinary restlessness; and in another, the subconjunctival injection of about 8 dr. of a 3.5 per cent. solution produced convulsions and loss of consciousness. In this class of cases the strength of the solutions used varied from 2 to 4 per cent. The quantity generally varied from 2 to 4 drops. The subjects were in some cases feeble, aged women; in others they were strong and healthy individuals, both male and female. (Communicated by the Hughes Medical Club of Massachusetts, to which the Eds. are indebted for most of the material relating to cocaine.)
6. Six cases have occurred to Dr. Keyser, in which the development of panophthalmitis was directly traceable to the use of cocaine locally during operation. The strength of the solutions used varied from 2 to 4 per cent; those used in at least 3 of the cases were known to be fresh, and microscopic examination showed no micrococci or deleterious substance to cause the inflammation. In viewing his cases, Dr. K – notices that the inflammation. arose just or much like that after the use of the jequirity in trachoma, except that there was more swelling of the ocular conjunctiva, and even more than and some what
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.