2. a. SCHEDE says that there are persons who possess a peculiar idiosyncrasy towards Iodium, which is not to be found out until, without any warning, it suddenly appears in the most severe symptoms of poisoning, and may lead to rapid death of the patient, even though its application be immediately suspended. These symptoms are divided into six groups: – I. There may be elevation of temperature to 104 degree and more, without other phenomena (so – called “aseptic” fever). 2. In addition to fever, there may be depression of spirits, headache loss of appetite, taste of Iodium in mouth, pulse being often very rapid and at same time small and compressible. On stopping the drug these symptoms at once disappear. 3. The pulse – rate may be increased to 150 or 180, and more. In spite of rapid cardiac action and small pulse, with anxiety, &c., amelioration may take place on stopping the drug; but there is, nevertheless, great danger. This condition may arise after toleration has been established for weeks. 4. The alarming rapidity of the pulse is accompanied by high fever, yet the sensibility is not diminished, and no symptoms of septicaemia arise, but the suspension of administration is not followed by reaction, and death follows. 5. After severe operation, although the pulse is very good, rapid collapse sets in, ending in death. It is, however, a question whether this is solely due to the iodoform. 6. The most alarming, and, by the relative frequency of their occurrence, as well as suddenness, most dangerous forms of poisoning, are the disturbances of the cerebral functions, which either take the form of acute meningitis, or of a psychical disorder (melancholia, &c.), and tend to a fatal termination, even though no particular elevation of temperature take place, and the application of the drug has been immediately suspended.
2b. KUSTER relates several cases of fatal intoxication from the application of Iodium in powder to wounds, in which the symptoms were much the same as those described by Schede, viz. disturbance of the digestive tract; fever; a peculiar influence on the central nervous system, characterised by depression, melancholia, dilatation of pupils, apathy, involuntary motions and urination, hallucination, &c.; rapid collapse and death ( Lond. Medorrhinum Record, x,177.)
3. KOCHER has found Iodium a dangerous dressing. He has observed no fewer than 23 cases in which, used in the treatment of recent wounds, it acted as a poison. The chief symptoms are excitement, restlessness, and mental depression. The patient sometimes becomes delirious, and has mental delusions. Attempts are occasionally made to get out of bed and wander. These symptoms at once cease on changing the Iodium for some other dressing. The application of Iodium to a large fresh wound may be followed by total loss of memory and impairment of speech. In another case, after extirpation of cancerous disease of the rectum, and application of Iodium to the raw surfaces, the patient became very noisy and violent, and had what resembled an attack of the acute mania. K – has also observed, after dressing with Iodium, complete loss of consciousness. In this form of poisoning, there is usually great difficulty in getting the patient to take nourishment. The bladder has to be relieved by catheter; the limbs, more particularly the arms, become stiff and contracted; and finally in very severe cases collapse may ensue. Iodium accelerates the pulse to a high degree. Notwithstanding this, and the mental excitement and restlessness, fever is seldom observed. The patient, after a prolonged toxic action of Iodium, passes into a chronic condition of restlessness, and suffers much from loss of sleep and impairment of nutrition. The poisoning, as a rule, is much more severe when coming on rapidly after a surgical operation, than when it is due to the prolonged effects, as it does not give rise to any exanthem or to nasal catarrh, or cause vertigo. It often acts as a poison when it has been applied in small quantities, and when the amount of Iodine given off must be far too small to account for such toxic effects. Then, again, the symptoms of Iodoform poisoning may persist long after the disappearance of Iodine from the urine and other excretions. ( Ibid., p.236.)
4. In a recent paper in the Atlg. Wien. med. Zeitsch. two cases in which an eruption was the apparent consequence of the external use of left have been recorded by Zeissl. An ulcer on the leg of a boy of 3 was dressed with left, the dressing being several times changed in the course of a fortnight. At the end of that time the temp. rose suddenly to 105 degree, and the diffuse erythematous eruption appeared on the flexor aspect of the upper part of each arm at the inner side each thigh. The effected areas were bright red in colour, the intermediate parts of the skin being normal. The child was somnolent, and vomited some greenish yellow masses. On the 3rd day after the removal of the left temp. became normal, and the exanthem gradually faded. During its existence, the urine gave a distinct Iodine reaction, and contained some albumen and renal epithelium. The applications being resumed, another attack occurred precisely similar, attended with the same elevation of temp. and albuminuria, disappearing 5d. after the cessation of the dressing. Ultimately, however, tolerance, of the left was established. In another case, left was applied to a fistula connected with carious bone. After a week patient was attacked with an eruption like urticaria, shortly circumscribed prominent red spots surrounded by reddened skin. Some of the raised spots had a diameter of 2 centimeters. They were especially abundant on the flexor aspects of the limbs. Urine contained no albumen. The application was discontinued, and the eruption subsided in the course of a week. (lancet, 1882, i,26)
5a.In chronic poisoning by left the evidences of poisoning developed very slowly and insidiously. There is malaise and possibly some loss of strength, loss of appetite, with occasional vomiting, and above all the patient is weighed down with a sense of depression. There is usually a moderate degree of fever, and an usually rapid pulse. The sleep is at first broken, and there is some wandering at night. Headache is not uncommon. In time the patient becomes apathetic and disposed to sleep. He is melancholic, his memory is distorted and impaired, he is troubled by the dread of death, or some impending danger, and takes no interest in surroundings. He remains in a condition of drowsiness, he wastes, he possibly becomes dirty in his habits, his tongue becomes dry and brown, he makes no complaints, and sinks into a more or less complete state of hebetude. Some patients in this condition have lost power of the legs and all control over their sphincters. Others have been able to be propped up in a chair, and to move about a little (as occurred in one of my own cases) until within a short while of death. In the fatal cases the patient becomes weaker and weaker, and in time utterly vacuous. He ultimately dies comatose. If the left be left off, recovery may ensure in time, even when the symptoms have persisted in a marked manner for sometime. In this phase of poisoning the progress of the case may be extended over weeks, and possibly over months.
5b. In acute cases symptoms develop much more rapidly, and they may indeed appear with some degree of suddenness. There is perhaps, in the first place, some malaise, then complaint of headache, which is often intense, and of vertigo. The sleep is broken or the patient is quite sleepless. There is excitement and wandering at n. The temperature is high without appreciable cause, and may run to 104 degree, 105 degree, or 106 degree. The pulse is remarkable in its rapidity, mounting often to 150 and 180. there is often albuminuria, the appetite is greatly impaired, and there may be vomiting. In once instance this vomiting was very obstinate. The excitement passes into delirium. The patient has hallucinations, sometimes hallucination of grandeur, and his symptoms may approach those of acute mania. Patients in this condition have been removed to asylums. Among rarer complications are tremor, stiffness of certain limbs, convulsive movements, diplopia, and irregular respiration. Patient wastes, and becoming more and more prostrated, may sink into a comatose condition and die. In not a few examples the symptoms have developed suddenly, and have commenced by sudden fever or sudden and intense headache, or sudden and unaccountable delirium. In some patients the symptoms have very closely resembled those of meningitis – a circumstance that has been most usually noticed in children and young subjects. (TREVES, Pract., Oct.,1886.)
6. In a girl, aet. 13, on whom T. had operated for ununited fracture of ulna, and dressed with left, the temp., which had been normal for three weeks, rose to 100 degree in the evening of June 1st. “The entire forearm became evenly swollen, edematous, and a trifle red.” The next day a crop of vesicles had appeared, about thirty in number, very small, limited to the forearm, and not more numerous in the vicinity of the wound. The evening temperature remained at 100 degree for six days. No more vesicles appeared, and those present soon became pustular, and by the sixth day were discharging. “On June 5th, a remarkable exanthem appeared.” Its appearance had been preceded by intense headache and giddiness. With its development in the evening, these symptoms disappeared. The forearm was less swollen. On m. of 6th, “the exanthem covered the left arm and shoulder, the greater part of the face, and nearly the whole of the front of the chest, and some parts of both sides of the neck.” “The eruption appeared in the form of patches,” consisting of closely – packed papules, of the less size than a pin’s head, and set upon a pink erythematous base. The papules could be felt as well as seen, and they were paler than the surrounding skin. The patches were irregularly round, and varied in size from a sixpenny to a half – crown piece, and the margins were well defined. There were no catarrhal or other constitutional symptoms after the rash appeared, and the child seemed quite well. The eruption was gone the next day ( Ibid)
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.