4. The patient was an Irish girl, single, aet. 20. She was admitted to N. Y. Hospital April 10th, 1888, at 4 p. m. She had taken on previous evening two tablespoonfuls of K. chl. by mistake for Rochelle salts. On admission she was in a state of profound prostration; temp. 99 degree, pulse 136, resp. 32. Surface was very cyanotic; breathing rapid, but not laboured; pulse very feeble. She vomited freely before and after admission. In spite of whisky, digitalis, and strophanthus, symptoms grew worse. At 6 p. m. temp. had risen to 104 degree. During n. bowels acted 3 times, motions dark brown and semisolid; dark coloured urine was passed involuntarily. It was proved to contain many blood cells, large masses of altered haemoglobin, and much albumen. Next m. temp. fell, and pulse and resp. improved for a new h; By noon pulse and heart were again profoundly weak, and temp. rose to 101.2 degree. There was a very extraordinary colour of skin, conjunctive, and lips, an intense anaemia with a cyanotic hue, and a very distinct sepia – brown chocolate tint where epidermis was thin; also great restlessness. Inhalation of oxygen produced no improvement. She slept constantly, and died 37 hours after poisonous dose. At necropsy, colour of blood was not materially changed, and a slight hue of jaundice was added to the anaemic and chocolate colouring. Blood in the great vessels was liquid, and of very dark chocolate colour. Heart was soft and flabby; lungs normal, but cut surfaces very brown. Spleen was large and firm. Kidneys large, capsules non – adherent, surfaces smooth; bladder contained 3 oz. of urine, of dark brownish – black colour and not at all translucent. All viscera were coloured like blood. Microscopically, very extensive fatty degeneration of heart was evident, especially in papillary muscles of left ventricle. Many straight tubes in pyramids of kidneys were found filled, even to distension, with broken – down blood – cells and methaemoglobin. Spectroscopic examination of blood revealed spectrum of methaemoglobin with much distinctness. Conversion of haemoglobin into methaemoglobin explains dyspnoea and altered colour. (PEABODY, N. Y. Medorrhinum Rec., July 21st, 1888.) 5. Man, aet. 53, had been for two years in the habit of taking K. chl. largely for chronic throat trouble. He looked very pale and waxy. He fell ill with feverish sore – throat, after having taken more of drug than usual; became very anaemic, passed no urine, vomited, and was jaundiced. He became steadily weaker, and died comatose. P. M. appearances were as in former case, but spleen was xix times its normal size. (lbid.) 6. A healthy young man, aet. 22, had incautiously gargled with a strong solution of potass. chlor., in course of which he had swallowed a considerable quantity. The following day he complained of sickness and of pain in the sides and loins. Signs of acute gastritis rapidly followed; nausea and severe pain in the splenic region were the chief symptoms. Some enlargement of the spleen detected. Heart and lungs were normal, but distinct cyanosis, especially of lips and extremities, was present. Two days after the poisoning severe vomiting set in and lasted till the end. Icterus followed, but disappeared before death. On 4th day severe epistaxis; extreme praecordial anxiety followed, but without any notable signs in the heart or lungs; and some rigidity of muscles of extremities was observed. Death took place on 8th d. Throughout the illness hardly any urine was passed. Temp. subnormal; pulse fair. P. m., 4 d after death, revealed brown colour of blood – vessels; it was normal to spectroscope. Spleen greatly enlarged, brownish in places, and capsule soft. Kidneys enlarged and cortical portion expanded. microscopically, the straight and convoluted lobes were found filled with numerous brownish, irregular – shaped masses of haemoglobin. The stomach showed acute and chronic catarrh, with a few ecchymoses. The large intestine and rectum contained a large quantity of brownish watery fluid, and the mucous membrane appeared oedematous. Other organs normal. (Medorrhinum Times and Gaz., 1883, ii, 526) 7. a. VON MERING discriminates between acute and subacute poisoning by the chlorate. In acute cases – such, for instance, as result form one large dose, death results in a few hours from decomposition of the blood, with symptoms of severe vomiting, profuse diarrhoea, intense dyspnoea, cyanosis, and profound cardiac depression. After death a chocolate – brown colour of the blood is seen, while the tissues generally are relatively very little changed. The blood contains methaemoglobin, &c. With less acute forms death results from the accumulation of oxidation products in the organs as well as in the blood, especially in the kidneys.
b. The following conditions are seen: Grayish – violet petechiae, icterus, accumulation of haemoglobin in the blood, changes in the red corpuscles, dyspnoea, and cardiac depression; gastro – intestinal disturbances such as profuse diarrhoea and severe vomiting, the vomited matter being generally greenish black; and enlargement of the liver and spleen. Functional alterations in the kidney, such as anuria, occur; the scanty, turbid urine having a reddish – brown or block colour, and exhibiting spectra of methaemoglobin and haematin, and being also highly albuminous. It also contains numerous detritus – masses of red blood – corpuscles in the form of brownish cylinders or flakes. Neuroses, uraemic convulsion, delirium, coma and rigidity of the limbs are observed.
c. The subjective phenomena are: headache, anorexia, tenderness of the stomach on pressure, pains in the hepatic and lumbar regions, intense oppression of the chest, and a feeling of extreme weakness. After death the characteristic chocolate colour of the blood is noticed; the spleen, liver, and kidneys are considerably enlarged and filled with accumulated products of destruction of red corpuscles. The greatest alteration is seen in the kidneys, in which both the straight and the convoluted tubes are filled with cylindrical or irregular brownish masses. The osseous marrow is brown and contains many decomposed blood cells. The gastric mucous membrane is swollen and ecchymosed. (Lond. Medorrhinum Record,, 1884, p. 518) 8. A man, aet. 49, was ordered pot. chlor. on account of a vesical catarrh following gonorrhoea. He took by mistake 60 grammes (2 oz.) in 36 h. When seen by Dr. Bohm he was pale and collapsed, in a condition very suggestive of cholera, suffering greatly from pain over stomach, and with suppression of urine. Soon after a feeling of numbness and formication in the hands and feet came on, causing great distress and restlessness. The urine, blood, and the P. M. appearances were such as have been already described in other cases. (Ibid., 1883, p. 436.) 9. Dr. F. MARCHAND has recently published four cases observed by himself (Virchow’s Archiv, Bd. 77, Heft. 3), three of them fatal, and had found that the P. M. appearances and the microscopic alteration of the blood coincided with those observed in animals experimentally poisoned with potass. chlor. The ages of Dr. M. ‘s patients ranged from 3 to 7 years. The dose varied from 12 grammes in 36 hours to 25 grammes in 30 h. The symptoms were vomiting, haematuria, a more or less icteric tint of skin, rapid wasting of flesh and strength, delirium, and coma. The urine contained quantities of disintegrated blood-corpuscles. The blood itself was of a remarkable chocolate colour, which did not alter on exposure to air. The same colour can be produced artificially by adding chlorate of potash to blood. If the proportion of the salt be considerable, the blood assumes a syrupy and even gelatinous consistence, and the red corpuscles tend to agglomerate into glutinous masses. The spectroscope shows that the lines characteristic of the haemoglobin have been replaced by a distinct absorption band in the red part of the spectrum, due to the conversion of the haemoglobin into methaemoglobin, an oxidation product of to former. The poisonous effects of the drug are therefore probably the result of its oxidising action on the red corpuscles. The debris thereof are either excreted by the kidneys, colouring the urine brown, or they accumulate in the renal cortex and cause death by suppression of urine and “uraemia.” The kidneys themselves are enlarged, and their surface is brown, but they exhibit no inflammatory appearances, the main alteration being the infarction of their tubules with corpuscular detritus. (Medorrhinum Times and Gaz., 1879, ii, 640.) 10. Hemoglobinuria produced by large doses of potass. chlor. – A woman was suddenly taken ill with cyanosis and dyspnoea, and passed masses of haemoglobin both per rectum and per vaginum; the urine and the vomited matter also contained masses of haemoglobin. On the 3rd day of her illness, the patient became slightly jaundiced, while the cyanosis passed off; on the 4th day she died. Beyond an enlargement of the spleen, which was painful to the touch, no organ was found during life the seat of disease. The blood showed increase of leucocytes, but the red corpuscles showed nothing very abnormal. The P.M. examination showed all the organs healthy except the spleen, which was large, soft, and looked like a blood – clot; the blood was fluid and dark brown; the kidney showed, in the cortical and medullary parts, chocolate – coloured streaks. The microscopical examination of the kidneys showed the convoluted tubes and straight tubes to be filled partly with granules and partly with small round discs of the size of blood – corpuscles, in which, however, the colouring matter was precipitated. The glomeruli were perfectly intact. The haemoglobin was not found within the glomeruli or in their capsules, but was abundant in the convoluted tubes, whose epithelium in most places was found intact. The patient had taken for a slight sore – throat about 1/1/2 oz. solid pot. chlor. (DRESCHFELD AND STOELLS, Trans. Internat. Medorrhinum Congress, 1881, vol. i, p. 398) 11. AMY W., aet. 3. suffering from purulent ophthalmia, was ordered, on March 9th, gr. chlorate of potash thrice daily. Much improvement resulted both locally and generally, and the medicine was continued until May 11th. The eyes several times seemed nearly well, but she had relapses due to unfavorable weather. Until May 11th the med. had apparently disagreed in no way; on this date the dose was reduced to 5 gr. “On May 18th she came with a very sore mouth. The saliva dripped from her lips, there were numerous follicular ulcer on the tongue and inside of lips, and one large one occupied a surface the size of a shilling on the back part of the dorsum of the tongue. The salivary glands were enlarged and tender, and the mouth full of saliva, although the ptyalism was not extreme, nor were the gums sore. In the latter respect, and in the existence of the larger ulcer on the tongue, the stomatitis differed from that caused by mercury.”( Medorrhinum Times and Gaz., 1858, vol. i, p. 527) 12a. A young man suffering from an acutely inflamed carbuncle on the nape took the chlorate in 15 gr. doses every 4 hours for 2 day, and then had 2 symmetrical ulcers from on the side of the tongue, each being about the size of a fourpenny piece. There was no general stomatitis, and the sores healed slowly when the remedy was suspended.
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.