20. Dr. WAINWRIGHT, a large and well-built man, aet. 40 was bitten in last phalanx of middle finger of left hand, near its articulation with metacarpal bone, about 6:30 p. m. At the time wound was made, bystanders observed that it was immediately followed by small jet of blood. It was immediately sucked, and within 1/2 hour an attempt was made to incise the part and incised surface was cauterized. From the nature of the part involved in the wound the incisions must have been imperfect. a ligature was also tied firmly round the wrist, and 10 gr. of carbonate of ammonia and 1/2 gr. of acetate of morphia were administered. about 7:30 ligature was removed. Previous to removal of ligature hand had been very much swollen, but no swelling had occurred above ligature; it now, however, began to extend up arm. At 9:30 patient was seen by Dr. Post, and soon afterwards by Dr. Parker. Swelling had now extended to about half way between elbow and shoulder-joints; it was very considerable, hard, and terminated abruptly. Hand was of a dark greenish-yellow colour; the discoloration did not extend as far as the swelling, but seemed to follow it at half an hour’s interval. At the time Dr. Post first saw patient, that is, about 3 hours after the accident, pulse was of medium fulness and strength; face was flushed, and manner excited; 1/2 hour afterwards pulse began to flag, and it became less full and forcible, increasing in frequency to 100. It afterwards reached 120; this was its maximum frequency, and it became constantly more and more feeble. By 11 pulse was extinct at wrist, but still to be felt in groin. Between 10 and 11 he became stupid, and took no notice of what was passing around him; this lapsed into complete coma, and he died a little past 12 o’clock, that is, about 5 1/2 hours after accident. By this time swelling had extended under pectoral muscle and discoloration had reached axilla. It is somewhat remarkable that after pulse had ceased at wrist and surface had become covered with cold perspiration, a sinapism applied to epigastrium produced full redness after 20 morning. The treatment, after Dr. Post saw the case, consist in the administration of stimulants (brandy and carbonate of ammonia), and when they could no longer be given by the mouth they were administered by the rectum. (Bost, Medorrhinum and Zurg. Journ., xxxviii, 65.)
21. a. EDDIE JEFFRIES, aet. 6, bitten by a rattlesnake on dorsal surface of right hand, August 31st, 1878, at 9 a. m. After 15 morning, whiskey was administered to extent of intoxication, and to wound was applied bicarbonate of soda saturated with brandy, but this was soon replaced by strong solution of ammonia. Above elbow a bandage was applied, but too loosely to be of use. I did not se the child until 3 hours after but bite, viz. at noon. Punctures were then plainly visible, corresponding to the two fangs in the upper jaw and to the principal teeth in the lower jaw. Immediate vicinity of bite was not swollen, gangrene having been immediately produced, but hand and forearm for 4 in above wrist were very oedematous, of livid colour, and shining; swelling of hand was so great that fingers were semi-flexed and separated. Child was delirious; hearing was dull; eyes closed – upper lids and superior recti being paralysed; pupils were slightly dilated and insensible to light; vision apparently lost. Eyes looked straight forwards; but when lids were forcibly opened eyes were directed outwards to escape the light, not, as usually, upwards. Countenance expressed calm indifference, with marked prostration and apparent freedom from suffering; lips and cheeks wee of their normal colour. There was no pulse at wrist, but auscultation showed heart to be beating about 100 per morning, with feeble impulse and remarkable shortness of the systo- diastolic interval. Respirations were rapid, 30 per morning. Skin of extremities was dry and cool, but not cold. Temperature, taken with difficulty, in left axilla was 96.4oF. Patient had repeated attacks of sickness, vomiting at first portions of undigested food mixed with a greenish fluid, then of thick viscid mucus like white of egg slightly stained yellow. Immediately on my arrival I tightened bandage so as to effectually occlude vessels of arm. Shortly after this there was one copious emission of urine, and afterwards child only passed small quantities of very pale urine. At same time watery diarrhoea set in, with colic and tenesmus. At 1 o’clock thirst was excessive, and was freely indulged; at this time also swelling had reached bandage, and seemed to the arrested there, though well-marked livid lines followed course of superficial vessels above bandage, pointing to probable disintegration of these vessels and extravasation of blood. From 12 to 3 there was great restlessness and some twitching alternating with periods of complete repose. In his delirium he uttered plaintive and feeble moans. There was paralysis of both upper extremities, particularly below elbows, and to a less degree, of lower limbs also. Child made repeated ineffectual attempts to stand up, but as soon as he got on his elbows and knees, or into the kneeling position, he fell back helplessly on his side.
21 b. As three hours had elapsed cauterization was useless; I therefore made a hypodermic injection of aqua ammoniae (1/4), and administered internally sp. amm. arom. with 3ss brandy, and ordered fresh milk for food every hour. Under this treatment reaction set in, pulse reappeared at wrist on wounded side, and vomitings ceased. At 3 patient expressed himself as feeling better, and now for first time after my arrival he complained of pain in head. I revisited him at 8 p. m., and found arm more swollen; blisters had been formed on various points on injured limb, skin had burst in bend of elbow, and a small quantity of extravasated blood was visible. The nervous power had, however, recovered to a remarkable extent; agitation and jactitation had entirely disappeared, and sense of taste had become as good as ever; hearing and even vision had become normal, and intelligence was completely restored, though thee was still some tendency to drowsiness. Respirations, however, still continued 30 per morning and pulse had again almost disappeared at wrist, remaining about 100. Temp. was now 97.1o in left axilla. Child complained of great pain in chest; and, the mother informed me, had, during my absence, had two convulsions, not severe ones. At 4, in violation of my orders, the mother had loosened bandage, because, as she alleged, his arm pained him much. This had allowed an additional increment of the virus to enter the circulation, which might account for the relapse. At 9:30 I again left him, and at my visit next morning I learned that the lad had died at 2:30 a. m., that is, 17 1/2 hours after bite. Death must have resulted from syncope, for the family said he went off very suddenly, “all at
once, ” when they were least expecting it. A post-mortem was refused, but the child’s face was of a light saffron colour, and the ears, the hand and the right arm were livid. (A. IRANS COMFORMT, M. D., Kansas, Phil. Medorrhinum Times, November 23, 1878.)
22. a. Severe prolonged case. – THOMAS SOPER, aet. 26. Bitten on back of 1st phalanx of right thumb and 2nd joint of forefinger at 2:30 p. m. on October 17th, 1809. Hand began to swell immediately, and within 1/2 hours swelling had extended half way up forearm, part had become very painful, and skin very tense. Within 1 1/2 hours swelling had extended to elbow, and within 2 hours had reached half way up arm, and pain had extended to axilla. skin was cold; pulse 100; answers were incoherent and he complained of sickness. After 5 hours pulse was very feeble. After 6 1/2 hour skin was still cold; pulse 80, weak, and there was feeling of great depression. After 8 hours there was much complaint of pain in arm, and fits of fainting attacked him every 15 morning; during these pulse was not perceptible, but in intervals spirits were less depressed. During evening he had two stools. After 9 hours hand, wrist, forearm and arm were much swollen up to top of shoulder and into axilla; arm was quite cold, no pulse could be felt in any part, and skin genially was unusually cold. Mind was collected. After 10 1/2 hours attacks of fainting came on occasionally, and he talk indistinctly; pulse 100; medicine was repeated every hours. At 8 a. m., on 18th, pulse was 132 and very feeble; swelling did not extend beyond shoulder to neck, but there was fulness down side, and blood was extravasated under skin as low as loins, giving to back on right side a mottled appearance. Whole arm and hand were cold, but painful when pressed. Skin was very tense. On inside of arm below axilla and near elbow vesications had formed; and under each vesicle there was a red spot in cutis of size of crown-piece. Skin generally over body had become warm. He was low and depressed; there was tremulous motion of lips, and faintings recurred at nearly same intervals as on preceding evening. Last dose of medicine was rejected by vomiting, but some warm wine remained on stomach; arm was fomented. At noon, in addition to above symptoms, there was starting of limbs. He had attempted to take some broth, but his stomach did not retain it. Skin of whole arm had livid appearance similar to what is met with in a dead body when putrefaction has begun to take place, unlike anything I had ever seen in so large a portion of the living body. Obscure fluctuation was felt under skin of outside of risk and forearm, which induced me to make a puncture with a lancet, but only a small portion of serous fluid was discharged. At 11 p. m., finding that his stomach did not always retain medicine, nor even small quantities of brandy, I directed volatile alkali to be left off, and gr. ij of opium to be given and repeated every 4 hours. At this time pulse was scarcely perceptible at wrist; fainting fits were more or less frequent, and vesications and red spots were increased in size. On 19th, at 9 a. m. pulse was scarcely perceptible, extremities were cold, vesications were larger, but size of arm was diminished. He was drowsy, probably from effect of opium. He had taken nothing but brandy during night. At 3 p. m. he was very he was very depressed, spoke in whippers; vesications were larger; vomiting fits less frequent; arm diminished in size, and he had sensation in it down to fingers. At 11 p. m. pulse beat 130, and he was low; opium was left off; a stool was procured by castor-oil; he was ordered to have a glass of camphorated mixture occasionally, and wine and brandy as often as he could be induced to take them. 20th. – He had dozed at intervals during night; his spirits were rather better, and his extremities warm. At 9 a. m. he took coffee for breakfast; he after wards took some fish for dinner, but it did not remain on his stomach; he took brandy and coffee at intervals, 3ss at time, as large quantities did not remain on his stomach. 21st – He had slept at intervals during night, but was occasionally delirious; pulse 120. brandy and jelly were only things that stayed on stomach. Size of arm was reduced, but skin was extremely tender. 22nd. – He had slept during latter part of night; pulse 98; he took some veal for dinner, and brandy at intervals. In evening his pulse became full and strong; he was ordered wine instead of brandy. The right side of neck and body down to loins was inflamed and painful, and had a very mottled appearance, from extravasated blood in skin. 23rd. – Pulse continued full, arm very painful, though reduced in size; vesications had burst, and the exposed cut is was dressed with white ointment. Stools were procured by opening medicine. He took some veal and porter for dinner; wine was left off. In evening he had saline drought with antimonial wine. 24th. – No material change. 25th. – Pulse increased in frequency; in other respects nearly same; bowels opened by medicine. 26th. – Arm more swelled and inflamed. 27th. – Inflammation of arm increased; tongue furred and pulse very frequent. He attempted to sit up, but weight of arm and pain prevented it. Arm was bathed with spirits of wine and aq. ammon. acetate. in equal parts. 28th. – A slough had begun to separate on inside of arm below axilla, and purging had come on; for latter he was ordered chalk mixture and laudanum. In night he had a rigor. 29th. – Purging had abated; pulse 100, and feeble. A large abscess had formed on outside of elbow; this was opened and half a pint of brown matter was discharged, with sloughs of cellular membrane flaking in it. Lower part of arm became much smaller, but upper part continued tense. A poultice was applied to wound; lower portions of arm and forearm were covered with circular straps of soap cerate. He was ordered to take bark, and was allowed wine and porter. 30th. – Redness and swelling of upper part of arm had subsided; pulse 100; purging returned. The bark left off and chalk mixture and laudanum resumed, and an opiate clyster administered. 31st. – Pulse 120, discharge from abscess diminished; purging continued; at night he had a rigor. November. Ist- Pulse 120, voice feeble, no appetite, delirious at intervals. Ulceration had taken placed at opening of abscess, so that it was increased in size. He drank 2 pints of water in course of day. 2nd. – Pulse very weak; countenance depressed; tongue brown; ulcers had spread to extent of 2 or 3 in; mortification had taken place in skin nearer to axilla. His stomach rejected every thing but porter. In night he was delirious. 3rd. – Mortification had spread considerably; purging continued. The forefinger, which had mortified, was now removed at 2nd joint. 4th. – He died at 4:30 p. m., that is, on the 17th day after bite.
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.