12. A man, aet.52, having pleural effusion, but otherwise (save for furred tongue) fairly well, heart and urine quite normal, pulse 70, was ordered infusion of D. 3 times a day. He at first measured dose, but soon began to guess it, and gradually increased amount. Shortly after doing this, appetite began to fail, he had bad taste in mouth, and tongue felt very dry. He felt also dull sickening pain over stomach, rising up line of sternum to throat. He felt weaker every days. This was about middle of November, about 3 weeks before symptoms attracted attention. He went on gradually increasing dose. When he lost his appetite he also got occasional headache; and along with the pain in epigastrium he had palpitation. Bowels were costive. About 3rd week in November he vomited once or twice after meals when seized with severe fit of coughing. Symptoms grew worse; he felt weaker and weaker, and less able to walk. About 1st or 2nd December he noticed his sight becoming dim; and when he looked at his own hands, or another’s face, they seemed blue. Pain in stomach was now almost constant, but headache was not much worse – most felt p. m. On morning of December 5th he complained of weakness and want of appetite. His pulse was found weak and ery irregular. At midday visit cardiac action was found increased, and pulse distinctly diacrotic; the general rhythm was about 2 beats in a second, and then an interval of about two seconds; pulse was 58, and somewhat feeble. Pupils were natural and skin moist; urine depositing lithates freely, otherwise normal. He got 3iij of brandy before I saw him, which I did about 520 p. m. At that time cardiac impulse was very abrupt and felt strong; pulse was 66, and very irregular. He omitted the D. and took brandy and sp. amm. arm., under which dimness of vision and pain at epigastrium gradually diminished up to 8th, when he had (p. m.) rigors, and went to bed complaining of intense frontal headache. This better next day, but continued to some extent up to 19th, when record ceases. It was over right or left parietal and frontal bones, chiefly about parietal protuberances, never in vertex or occiput. Pulse was regular by 13th. (BRUNTON, on Digitalis, 1868.).
Experiments on animals
1 a. In 6 or 8 hours after giving a large dose of D. to horses they stand at the stretch of their halter, sad, dejected, and without appetite, and their coats lusterless and rough. Then signs of general excitement appear. Conjunctivae are injected and of a bright red; eyes brilliant and fixed; face pinched; nostrils dilated and quivering; respiration hurried, number being 15 to 20 or 25 in morning; circulation more rapid, beats of heart being abrupt, their energy much increased, and accompanied after a certain time by a vibratory thrill, with decided metallic tinkling, and as poisoning goes on a distinct bellows murmur becomes audible, and is rendered louder by any exertion; beats then show decided intermittence, and pulse is small, thready, an intermittent; heat of body is increased; hot sweats appear on ears, nose, shoulders, and flanks; mouth is hot and filled with saliva, which is sticky and scanty; tongue is of purplish red at its tips and edges, and is covered on dorsum by a thick coat, which gives it a leaden hue; faeces are of their normal form and colour. During the first 12 hours the animals often show signs of transitory intestinal pain.
1 b. At the end of 24 or 36 hours stage of excitement has passed and animals become comatose, their heavy heads hanging down towards litter of kept at bottom of manger, completely insensible to external noises or stimuli, their eyes fixed, without movement or expression, sometimes half covered by the fading lids, and at other times haggard and ready to sort from their orbits, pupils greatly dilated, and conjunctivae, previously of a light red, are now of a violet brown, and their secretion dried up. The previous acceleration of the respirations is now succeeded by great slowness, their number distending to 8,7, or even 6 per morning, and being deep, broken, and trembling. The heat of the body is diminished, the sweats stop, and the skin becomes cold. The faeces are now of a browner character, and covered with a layer of mucus more or less thick. The urine is at first suppressed but at the end of 36 or 48 hours is passed in abundance, pale, clear, and inodorous, great muscular weakness, staggering gait, oscillation of posterior extremities, and a kind of paralysis which slows their movements. In some case there are slight vertigo, in others spasmodic fibrillary contractions of muscles of face and of alae nasi. Severity of symptoms rapidly increases. Muscular weakness becomes extreme, the legs are no longer able to support the body, and the animals falls en masse. The respiration becomes more disturbed, sometimes jerking, difficult, and plaintive, more frequently very slow but in some cases slightly accelerated. In some it presents remarkable intermittency, and its time of stoppage coincides with that of heart when latter also intermits. In some cases 24 to 36 hours before death there has been noticed a paralysis of lips, chiefly upper, and a thick and stringy saliva flows from mouth. Diarrhoea appears, and quantities of a very foetid, soft, blackish paste are discharged, and when intestinal canal is completely emptied diarrhoea becomes serous, expelled matters being liquid, blackish, and of repulsive odour. Skin becomes icy cold; thermometer introduced into mouth, rectum, or subcutaneous cellular tissue standing in some cases at 31.5o, or even, before death, 25oC. Death generally comes on quietly but is sometimes accompanied by unconnected movements.
1 c. When given in doses less rapidly fatal, so that each dose would only produce slight symptoms which would soon pass away if dose were not carefully repeated, influence which it exerts on circulation is by far the most prominent phenomenon. At first there is slight excitement of heart and its pulsations are a little quickened, then later or they undergo a remarkable diminution, falling o 25 or even 20 per morning. If dose be still repeated beats become quicker and more energetic, rising to 55, 60, 65, and 70. The cardiac sounds are more clearly heard, more distinct from each other than normally, and following a different rhythm, there being occasional intermittence, usually after same number of beats, but this number varying in different subjects, and in the same subject according to date of poisoning. There may be 5 or 6 pulsations between intervals in some, 15 or 16 in others, and in yet others intermissions are completely irregular. as poisoning goes on metallic ringing appears and becomes more and more distinct and sonorous. Still latter a vibratory thrill appears and is followed by a bellows murmur. As death approaches beats of heart become more and more rapid, being 92, 100, or even 114. Beats of pulse correspond in time to those of heart, but as the latter increase in energy in same ratio the former become more and more feeble, and less and less perceptible, till at last when poisoning is complete it becomes completely imperceptible. In doses so small as to have no poisonous effect its action is shown first on the urine, and secondly on circulation. To show this Messrs. Bouley and Reynal give following typical case:
1 d. A Hungarian horse, of an excellent constitution, employed in the service of the Veterinary School of Alfort, aged 10 years. Normal state at time of experiment; Respiration 16, pulse 37, full, mucous membranes rosy, digestive functions intact; all the signs of health. January 1st, 1849, 11 a. m., 6 grm. of D. powder were given in. electuary when animal was completely fasting. 2 p. m., respirations 14; passed water, which was clear and plentiful. 6 p. m., respirations 13, pulse 35; water always passed in abundance and with same limpidity. Next day effects had appeared. 4th, 10 a. m., 6 grm. given as before. At time of giving respirations 16, pulse 37. 3 p. m., respirations 14; urine clear, abundant, and odorless. 6, respiration, circulation, and urinary secretion same. 8, respirations 13; cardiac beats a little diminished in intensity, otherwise quite healthy. 5th. – 7 a. m., conjunctivae pale, pulse 22, small, and not well felt; beats of hart diminished in intensity, remain quite distinct, marked intermittence after each beat; respirations 6 to 7. Noon, same state. 2 p. m., pulse 25; intermittence less sensible; respirations II; urine always clear, less abundant. 7 p. m., lying down quietly; litter much soaked with urine; pulse 30; intermittence disappeared; respirations 15. 6, all symptoms of med. disappeared and functions return of their normal state. 8th. – Six grm. of D. At moment of administration pulse 30, respirations 10 to 11, thermometer in rectum 38:75oC. and 31:25oC in nasal cavities; all signs of health. 1 p. m., nothing particular. 4, pulse 28; no change in rhythm of heart; respirations 10; urine clear and in considerable quantity; temperature 36:25oC. in rectum; a little tenderness of abdomen. 8 p. m., appetite good 26; cardiac pulsations ringing; respirations 14; urine always abundant. 9th. – Conjunctivae pale; pulse 24, small, hardly sensible; beats of heart enfeebled; respirations 6; temperature 36:25oC. 2 p. m., mucous membranes more coloured; pulse 30; beats of heart enfeebled; respirations 6; temperature 36:25o. 2 p. m., mucous membranes more coloured; pulse 30; beats of heat more intense; respirations 12; urine less abundant and less limpid; functions now began to return little by little to their normal state. In almost every case which they experimented on the history was exactly the same. (BRUNTON, op. cit.).
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.
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