8 b. Unless given in dangerous doses, G. ordinarily affects first and chiefly eyes and brows – pain in brows followed soon by giddiness, then by pain in eyeballs, and soon after by dimness of sight. A larger dose produces double vision without apparent squinting, with sense of great heaviness of upper eyelids, and somewhat contracted pupils. A still larger dose causes drooping of upper lids, sometimes so marked that edges become nearly closed., and can be opened only by strong and painful effort; and, after straining to open them, sometimes the lid is so tired that ptosis for a short time becomes complete. The movements of the eyeball are restricted (associated in one case with a strong double internal squint). The patient next complains of weakness in his legs, and we have never pushed the drug beyond the production of this symptom. When decidedly under drug’s influence, patient is pale, with a heavy sleepy look. Some say their eyes feel sleepy; others yawn frequently, and say they can hardly, keep awake, and when left to themselves fall asleep. Others complain of dryness of mouth, though tongue looks moist, and to finger feels so. Some keep moistening mouth with a little water even hours after discontinuance of medicine. These symptoms (except the squinting) were all produced in the greatest number of cases; but in some instances even large doses of tinct. induced only a few of the slighter symptoms. Thus, a woman took a drachm dose hourly, for 6 hours, without exciting headache, diplopia, or giddiness- only great heaviness of eyes, and dimness almost amounting to temporary loss of sight; though on a former occasion, in this very woman, we produced extreme diplopia with giddiness with four 3j doses. In one instance diplopia occurred without precedent headache giddiness, and dimness of sight; though subsequently, in this same woman, we produced with six 3 doses hourly much giddiness and mistiness without Diplopia.
8 c. The symptoms from G come on early and soon subside. a single drachm dose rarely produces any marked symptoms; but in 10 – 15 morning after the second hourly dose the symptoms appear, and reach their highest point in about 1/2 hour quickly subsiding, so that most of them have ceased in an hour. After 4-6 hourly drachm doses the symptoms may persist 6 -8 hours after last dose; but they are most marked 1/2 hour after each.
I shall now describe each symptoms separately and fully.
Pain in head and eyes patients described this pain variously. it was generally limited to the forehead, and most marked just over the eyes. Some called it a dull sensation over the eyes; others, a heavy pain; others, a giddy pain; and one patient experienced pain over the occiput, with sensation as if crown of head was being lifted off in two pieces. This headache was sometimes absent, sometimes followed instead of preceding the other symptoms. Dull aching pain in eyeballs, now then shooting in character, occasionally worse in one ball, sometime followed and sometimes preceded the headache. The headache and pain in eyeballs were often severe, and were intensified on moving eyes. When ptosis was well marked, the effort to open the eyes widely caused considerable pain, and patient seemed to get relief by closing the eyes.
Giddiness This was another prominent and early symptom. Some felt it over the whole head; but by far the larger number said it limited to the brows. Standing or waking made it much worse. When well marked, the patients staggered, and were afraid even to stand, much less walk. So giddy was one patient that he nearly fell off the form on which he was sitting. Some described their heads as going round and round. They felt and seemed drunk, though without any incoherence or mental excitement.
Sight In every case the sight was affected; indeed, dimness of sight and giddiness appear to be the most constant symptoms, and may exist without headache, pain in eyeballs or double vision. at first the sight without being misty, is not so clear as usual; then slight mist comes before eye, one patient comparing it to smoke, and another to a thick veil. At last sight fails almost completely, and first with distant objects; with further impairment of vision, nearer and nearer objects look hazy.
Diplopia The drug seems to produce two kinds of diplopia, one much more persistent than the other. As to the transient kind, we find it, on many occasions, a very passing phenomenon, lasting only a few seconds, then disappearing, then after a few morning reappearing. In this transient form images in the median vertical line appear double, distant objects first undergoing the duplication. Sometimes the patient was conscious of the onset of the diplopia; thus one woman said, “I know it is now coming on; I feel such a heavy weight under my upper eyelid. ” The double vision then came on; and, with the heaviness, passed away in a few seconds. One image was higher than the other, the images in this respect varying much. Mr. T. Fox rapidly recorded, from the patient’s lips, the phenomena occurring, as fast as they could be written; – “One gas jet appears about 6 in. above the other, and there are 6 in. between them horizontally; the upper one is to the left; now the right is uppermost, now the left slightly again; going over to right now again; exactly over one another now, and quite close together; now again separated, left highest; now over one another.” With other patients the two images seem on a level. Sometimes the drug produces only this transient kind of diplopia; at other times both kinds; and sometimes one kind persuade the other, the transient usually preceding the more constant form, recurring from time to time, while the consent from persisted. The phenomena of the constant form follow a definite order, and take place in the upper half only of the field of vision. They occur at first with objects held at the extreme right or left of the visual field, and as the patient comes more under the influence of the drug, with objects held nearer and nearer the middle line; and at last, usually for a short time only, objects in th median vertical plane seem double. As the effect of the drug wears off, the double vision disappears in the inverse order. The outer lateral image is the higher, and the farther the object is carried to right or left the greater is the horizontal or vertical distance between the images. When a coloured glass is placed before either eye, the outer and higher image is seen by the covered eye. When the object is carried high above the head, the two images gradually coalesce and the object looks very much thinner, “like a thread. ”
8 h. With well-developed diplopia, there is impaired movement of the eyeball, chiefly affecting, as far as could be ascertained, the external and internal rectus, especially the external, for the outward and inward movement of the eyeball is less free than before the action of the medicine. The ball when carried as far as the weakened muscles are capable of is oscillates as though patient, with a great effort, moved it as far as he could, and then the tired muscles gave way a little, but, being roused to an effort, they carried the eye back again, th frequent repetition of this effort giving rise to an oscillation. The external rectus is generally first affected, and one not infrequently sooner than, and in excess of, the other. Even when the Diplopia is strongly marked, the loss of power over the muscles is not very react, and there is no obvious squinting. But as the patient becomes still more affected, ptosis supervenes; an a great part, or the whole of the upper half, of the field of vision is cut off. The loss of power in the eye- muscles is then more marked, nd the symptoms are irregular and variable.
8 i. To test the effect of G. on the circulation, I made 33 series of observations on patients in whom we induced the full toxic effects. The observations were taken every 1/4 whilst patient was fully under the influence of the drug, and subsequently, as its effects began to decline, at hourly internals. In 22 instances pulse remained unaffected in frequency, whilst in 11 it was quickened, increase ranging from 6 to 12 in morning. Curiously enough, even in same patients, effects were variable; for although on some occasions drug quickened pulse, on others it failed to fact it. This was not a mere question of dose, for increase in the dose did not affect the result. With a patient fully under influence of drug we were inclined to think pulse became a little smaller and softer.
8 j. I have carefully watched for, but have been unable to detect, any influence on the mental faculties. Patients under its influence look dull and heavy from the dropping eyelids, and often feel sleepy; but when asked if they are conscious of any mental depression they always answer decidedly in the negative. Nor is cutaneous sensibility affected. I have tested sensibility roughly by pricking and pinching, and also in 2 cases by compasses, but was unable to detect any loss of sensation in face or forearm, though patients had taken for 6 consecutive hour drachm doses of tinct. One patient, on both occasion on which I experimented upon him, complained spontaneously of a numb pain and a little tenderness along teeth and edges of gums of upper jaw.
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.