10. P. J -, aet. 25, came May 2nd into the hospital. The previous day at 6 p. m., after drinking a quantity of spirits, he scraped off the heads of 3 packets of phosphorus matches, put them into a glass of beer, and drank the mixture. He continued drinking wine and beer till 10 p. m. At midnight he vomited a quantity of blackish – brown, metallic tasting fluid, and vomited 10 or 12 times before m. He came to the hospital at 7 a. m. He complained of headache, dryness and metallic taste in palate, slight burning sensation down oesophagus to stomach, anorexia, thirst. Tongue dry, brownish black, fauces red. Pulse full, regular, 72. Liver normal as to size, spleen somewhat enlarged. Stomach towards pylorus tender to pressure, an uncomfortable feeling in it, but no pain. Magnesia hydrica was administered, and he got milk to drink at his own request. When seen, evening, he had had 3 stools, and had vomited once. – 3rd. M., the pains in stomach increased, nausea repeatedly during d. Pulse quiet, 72 – 76. The skin, especially on chest, yellow; urine dark – coloured, contained a quantity of bile – pigment, no albumen. He got ice pills, mistura oleosa, and cold compresses to gastric region. – 4th. N., copious vomiting and 1 purulent stool. Complained of increased headache, pulse 88. Skin jaundiced, covered with perspiration, albuginea of both eyes yellow, urine dark brown. Stool black, owing to decomposed blood. Liver increased in size, very tender. – 5th. No change. – 6th. The same. Urine brown, sp. gr. 1021, acid, great sediment, urophein diminished, uroxanthin increased, urea diminished, uric acid increased, no chlorides, earthy and alkaline phosphates increased, sulphates increased, much albumen and urates, much bilophaein and uroerythrin. Sediment, urates and earthy phosphates. – 7th. In the n. vomited 5 times, one stool, icterus increased. Evening, when lying asleep on left side, his whole body shook violently synchronously with each heart’s beat, a loud blowing sound could be heard in the aorta at each systole. – 8th. After a sleepless n. he fell into a somnolent state, answered questions slowly and with difficulty, and his speech was disconnected. Colour of skin intensely yellow; temperature high. Tongue very dry, with thirst, blackish – brown fur. Liver projected below ribs, and the tenderness of it increased. Pulse 108. At the evening visit the somnolence had increased, pulse softer and slower, sound in aorta as yesterday. Liver decreased in size. – 9th. All n. cried out, made constant attempts to get out of bed, had to be tied into the bed. At 2:30 a. m. he fell asleep, and slept till m. Countenance fallen in, dull look; lips, nose, forehead, and extremities had a livid hue, temperature of extremities low. Respirations slower and accompanied by loud rales. Size of the liver much diminished; pulse very small, soft, 132; blowing sound in aorta very distinct. Since m. frequent convulsive movements of lower extremities; when this happened the feet were drawn into the appearance of club – feet. During a. m. convulsions of upper extremities also occurred; trismus came on, so that it was impossible to get liquids into mouth; there was loud rattling both in inspiration and expiration. A quantity of dark frothy blood was discharged from the nose and mouth during expiration, which, as well as the body, had a cadaverous odour; extremities cold, radial pulse could not be felt, and at 4 p. m., after a rapid succession of convulsions, he died. – P. M. Dura mater pale, icteric tinge, vessels moderately distended, brain soft, in its cavities some drops, in base of brain 1 drachm, of pale yellow serum. The intermuscular cellular tissue of neck and mediastinum, as well as the sub – pleural cellular tissue of the thoracic walls, studded with numerous patches of extravasated blood. Back of tongue and m. m. of fauces covered with a blackish – brown slimy substance. right lung adherent at the back; both lungs inflated, mostly bright red, containing fluid blood, in parts edematous; the lower lobes interiorly somewhat swollen, dark red. In pericardium 1 oz. reddish – yellow serum; heart collapsed, at its base ecchymosed; the endocardium, especially of right side, yellow tinged; cardiac muscular substance fawn – coloured, in heart’s cavities fluid blood. Liver small, contracted, wrinkled, tough, bloodless; when cut into, fatty, yellow and red – that it to say, on a red basis of interlobular tissue the acini appeared as icteric – yellow granules the size of millet seeds. The acini under the microscope were seen to consist of large and small fat drops with a few hepatic cells among them whilst in the interlobular tissue no cells were visible. Gall – bladder contained slimy blackish – green bile. Spleen very long – shaped, reddish brown, some of the splenic elements changed into aggregation of fat – globulets. Stomach, duodenum, and upper part of jejunum filled with blackish – red and black tar – like fluid. M. m. of stomach pale, numerous haemorrhagic erosions on the pyloric end. In the rest of the small intestine grey pappy matter. Kidneys large, their cortical substance swollen, yellowish red, fawn – coloured, the pyramids dark coloured. Under the microscope the the urinary canaliculi of the cortical substance appeared dilated, filled with fat – globules, epithelium gone. In bladder 1/2 pound of orange – yellow urine. The urine taken from the body of a reddish colour, acid, with sediment of urates. The chlorides were in diminished quantity. A small amount of albumen and a large amount of bile pigment. (KARAJAN, Wochenbl. d. Zeitschr. day k. k. Ges. d. Aerzte in Wien, 1863, 20; in A.h. Z. Mnt. Bl., viii, 29.)
11. a. On 5th June, at 8 p. m. 6 hours after eating, Maria L – swallowed the combustible matter of box of matches suspended in a cup of coffee. In about 3/4 hours she felt severe pain in throat, sense of swelling in tongue and of pricking in epigastrium. Pain was paroxysmal, at intervals of about 5 m. The woman experienced great sense of fatigue, and there was a peculiar insensibility in the skin of the extremities. 6th. – Frequent and considerable nausea, without vomiting. The feebleness experienced did not prevent her from walking about all day in the rain. Numbness of extremities with formication; sensibility of fingers so much diminished that she could not pick up a pin. Pain along pharynx and oesophagus. Towards evening an incomplete attack of syncope; was then brought to hospital. She was pale; features slightly changed; had lively thirst; epigastric pains more marked; skin dry; pulse normal. An emetic was administered, which occasioned a little vomiting. 7th. – Diminution of epigastric and pharyngeal pains; frequent painful regurgitations, with expulsion of gas having an alliaceous odour; commencing jaundice; chills. Very weak; intelligence intact, calls for food. 8th. – The pains are dull; bad taste in mouth, nausea, without vomiting; somnolence. The jaundice is very decided; the liver is sensitive to pressure, projects a very little beyond the false ribs; more chills. (A purgative was given.) At 4 p. m., chills more intense; febrile condition. 9th. – Same symptoms; pulse 50 – 60; no appetite. 10th. – Same. Upon arms some red spots, which disappear on pressure. Pain in hepatic region. (Leeches to anus, on 11th calomel and jalap.) 12th. – Pain in liver easier after leeches, and now better still. 13th. – Augmentation of hepatic pain; liver very tender on pressure, extends two fingers’ breadth beyond edge of false ribs; formication in fingers. (Blister on right hypochondrium.) In n. delirium suddenly supervened, followed by a comatose state, interrupted by occasional screams. 14th. – Delirium, coma, dyspnoea, yawning, difficult articulation. 15th. – Still coma; cries; trismus; death.
11b. P. M., 24 hours after death. Very slight vascularity of cerebral pulp. Bloody serum in cavity of pleurae and pericardium; ecchymoses on costal pleura; pulmonary engorgement; heart small, collapsed, empty. Ecchymoses under peritoneum, and bloody serum in its cavity; stomach and upper half of small intestines full of bloody mucus; in all this extent mucous m. tinged uniformly of a wine colour from imbibition of the contained liquid; no softening or ulceration of the surface. Liver larger than natural, of deep brown colour and softened; spleen also enlarged and softened, with ecchymoses under its serous coat. Bladder contained a very large quantity of bloody urine and many ecchymoses under its mucous membrane; kidneys healthy. Subperitoneal ecchymoses on uterus and its appendages, and also between laminae of mesentery. (LEUDET, Arch. Gen. de Medorrhinum, Mars, 1857.)
12. a. A soldier, aet. 21, swallowed ends of 6 packets of matches. In 3 hours he was seized with vomiting, which recurred frequently and expelled much of what he had taken; pulse was frequent, tongue loaded, head hot; he complained chiefly of headache. (Emetic, cold to head, demulcents.) Next day headache less severe; pulse 92; stomach but slightly sensitive to pressure, but there were pains in each hypochondrium. P. m., turgescence of face had increased, also hypochondriac pains, but headache was gone; there was burning thirst, with dryness of mouth; urine was high – coloured and frothy, its sp. gr. was increased, and it was found to contain albumen and exudation cells; the colouring matter was augmented, as were also the sulphates and phosphates, while the chlorides were diminished. This state of urine continued throughout. Three day after Ph. had been taken, thirst and dryness of mouth, with hypochondriac pains, had increased, and there were darting pains in chest; epigastric sensibility was increased, and tympanitic percussion – sound over stomach more extensive. Tinge of face was brightened. (Leeches and ice to epigastrium; ice and magnesia internally.) The above symptoms persisted, and face assumed a remarkable bluish – red colour, except a colourless band of about 1 in. in breadth, extending from highest point of forehead down median line to chin, sharply defined, and giving face a most peculiar appearance. An enema produced a yellowish evacuation. On 4th day hypochondriac pains had somewhat diminished, but those of chest had become intolerable, without physical signs of mischief there. The bluish – red colour of face had changed into perfectly cyanotic hue, median line continuing colourless. Epigastric pain had ceased. Patient sweated profusely, and exhalations from body gave out an intensely phosphoric odour (which breath and stool did not). Patient, who retained perfect consciousness, stated that in the horizontal posture he could perceive a feeble ray of light, but that when he sat up he could not see at all; pupils were so dilated that only a narrow ring of iris was visible, and they were uninfluenced by light; he complained of darting pains in eyeballs. Pulse was 100, moderately full and strong; p. m., 140, small and weak. At this time hearing was lost, sweat profuse, extremities cool, and second sound of heart inaudible; he complained still of severe pains in chest. Soon after, he died quite tranquilly.
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.