11. a. There is an effect of I. to which I have alluded in the case just quoted, but which is so extremely common when the remedy has been pushed to an overdose, that it deserves to be noted at greater length. The anxiety and depression of spirits are so great and persevering as to warrant my considering them as the peculiar effect of the drug, and not the consequence of the great debility which attends the violent and inordinate action of this medicine on the constitution It is an affection very different from hypochondriacal melancholy, inasmuch as it dwells principally on the present, and has no reference to the future. Patients have generally described it to me as a sense of sinking and faintness, which were peculiarly oppressive, and I have heard them complain of it while suffering the most intense pain, as the part of the complaint which was yet the most difficult to bear. This symptom frequently makes its appearance in a lesser degree even when the medicine acts in a kind and salutary manner.
11 b. In certain persons I. cannot be exhibited so as to affect the constitution in any manner, without in some shape or other producing unpleasant nervous symptoms, such as dimness of vision, indistinct hearing, fallacious touch, insomnia, breathlessness, palpitation, and all the countless forms of inward nervous derangement. But the symptom most worthy of attention is a degree of tremor which generally comes on when the patient is under the full influence of the drug. This symptom may be reckoned a good gauge of the degree of nervous excitement which has taken place, and it is seldom or never absent when that excitement has proceeded to any considerable degree. It generally begins by slight trembling of the hands, resembling that which occurs from the poison of lead; and if the medicine be incautiously continued, the larger muscles of the arms, legs, and back become affected. When in this state the patient can with difficulty walk, and his progression is a tottering uncertain motion. He cannot carry anything straight to his mouth, but the hand moves in a zigzag manner, and with difficulty arrives at the mouth at last. This complaint is generally attended with a hurried articulation, and small thready pulse. There is commonly great suffering at stomach and confined bowels (in one case most obstinate suppression of urine.) If the medicine be rashly preserved in when this affection has begun to appear, it will go on progressively for weeks and months even though its exciting cause be abstracted; and when at last it does begin to diminish, the amendment is so slow and gradual that the patient is scarcely conscious of it. I saw two cases of this kind with Dr. Peschier, of Geneva, in which the patients had suffered more that 12 months, and yet their sufferings had undergone little mitigation. This affection differs from chorea. The patient has no difficulty in keeping the affected limbs steady, if not called upon the exert them and in general exertion is irksome and painful. Like chorea, however, it is always attended with a constipated condition of the bowels. (Ibid.).
12. Dr. Manson notices that in one example the remedy borough on such troublesome convulsive movements that the man asserted they were “like to twitch him out of bed, ” and begged for its discontinuance. An analogous example is related by Sir A.
Cooper, where 30 dr. of tinct., in divided doses, gave rise to the most unpleasant convulsions, the hands and feet fell into incessant motion, and the patient declared that the whole night long he resembled a person in the act of fighting of wrestling. Sir B. Brodie asserts that he has known it to occasion paralysis. (COGSWELL, ‘Iodine and its Compounds, ‘ 1837.)
13. I occupied, 37 years ago, a small student’s room, in which I remained for 4-6 hours by day, and for 7-9 hours at night. While absent from it the room was well aired. I was at that time a great collector and among other objects of interest I had amassed was a phial of the then new substance, Iodine, which stood on a shelf in my room, closed with a cork, and containing about 10 grm. of the metalloid. During the winter months. I experienced the first symptoms of a malady which for a time puzzled the faculty. I grew thin to such a degree as to disquiet my friends and fellow-students; and the professors whose classes I attended of their own accord questioned me closely on the subject of this extraordinary emaciation, which was as mysterious to me as to them. My skin became pale or rather dull. Sleep, till then natural and regular, was slow of coming on, insufficient and bad, frequently broken by dreams which rapidly succeeded one another. I felt a general excitement, which became greater and greater the longer I remained in my room; the open air calmed me. Thirst was augmented, but digestion remained normal I felt the need of taking food frequently, to restore failing strength. The sense of general lassitude increased Pari passu with the emaciation; pulse was quick and small. But the most pronounced and annoying symptom was priapism, lasting nearly all night and frequently accompanied by a painful sensation in the pins. I also felt stiffness and sometimes even pain in lumbar region (there was no albuminuria).
As I have said, both my teachers and myself were at fault as to the cause of these symptoms. During March the mystery was cleared up. I found that the york which had closed the phial of iodine had become corroded by the drug, which had in consequence completely evaporated. I analyzed the air of my room by means of starched paper, and the blue reaction showed the presence of I. in it. (L’ Hom. Militante, 3me annee, p. 399; a communication to the Editor.)
14. [Besides the local irritation caused by the tincture in the primae viae (already sufficiently illustrated), and the corresponding disturbance of the emunctories during the elimination of the alkaline iodides (see Kali iodatum), Dr. RILLIET describes a third form of iodism. In the cases he gives in illustration the medicinal agent was generally iodide of potassium in minute doses. One or more of these will be given under the head of that substance, but the general train of symptoms is so obviously the result of iodine itself that his description will be given here – EDS.]
14 a. The third kind of iodism is a specific intoxication produced by the drug or its compounds, more frequently seen from small than from large doses, and in cases of good general health rather than in those of diathetic derangement, more frequent also in some countries than in others, extremely rare in children, and the more to be feared the further advanced are the patients in age. It is the malady described by Coindet under the name of “iodic saturation, ” by others as “iodic cachexia, ” or simply “iodism. ” I adopt this last term, joining within the word “constitutional” the better to indicate the nature of this morbid state. This iodism may exist in all degrees of severity, but for convenience of description and for practical ends I shall class it under three heads: slight iodism, moderate, grave or very grave.
14 b. Slight iodism.-after the employment of the drug for a shorter or longer time, patients, while congratulating themselves on the diminution of their goitre (if they have one), notice that they are getting thin and pale, and that they are weakened; or rather, their friends notice these things, for they themselves are often deceived by the maintenance, even the augmentation, of their appetite. Upon the emaciation of spirits, sleeplessness, and a nervous susceptibility of more or less pronounced character. These symptoms may remain stationary, and disappears on the cessation of the drug. Sometimes they consist only of loss of flesh and palpitation.
14 c. Moderate iodism. – Here, it may be from the medicinal malady not being recognized, the symptoms increase, the emaciation sadness, insomnia, disposition to be frightened, and the palpitations, get worse; the appetite fails, or, on the other hand, increased to bulimia. Some patients complain of painful sensations in the stomach and at the attachments of the diaphragm; they are constipated; the countenance expresses prostration or a certain degree of excitement. The most careful examination finds no organic cause for this ensemble of symptoms, which persist for a longer or shorter time, but end by gradually disappearing under appropriate treatment and the discontinuance of the drug.
14 d. Grave iodism. – In this form the symptoms are distinguished only by the rapidity of their supervention and their intensity. The goitre (if present) diminishes or disappears in a few day; at the same time general emaciation comes on, sometimes with frightful rapidity so that in a few weeks, even in 8-10 days, the patients are hardly recognizable; they have become 20 years older. The marasmus is general, but it falls mainly on the glandular organs; the mammae and testicles waste. The pulse is quickened; it is rather small than full, and faster at times than at others. The skin of the face is pale, yellowish, or greenish; the countenance expresses sadness or anxiety; the eyes, deeply sunken, with dark circles, are sometimes fixed, sometimes rather wandering. The weakness is great; the voice is broken; they tremble, and are breathless at the least movement. The nervous symptoms are very distressing, – inquietude, terror, easy weeping, have taken the place of repose of mind, and nightmare is substituted for sleep. Here also no organic change n be detected; and the appetite persists or even becomes exaggerated or perverted. The patients seldom keep their bed, and here again, under proper treatment, in a few weeks or months there may be a return to health; but not without traces of the past conflict lasting for some time or for all time. Permanent atrophy of the breasts in women, and of the testes in men, remain to bear witness to the shock the systems persist and grow worse, the brain is more and more implicated, and death supervenes in the midst of advanced marasmus. (RILLIET, Mem. sur l’Iodisme constitutional, Paris, 1860).
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.