12b. P. M. – Brain was pale, bloodless, and softer than natural; ventricles contained a minimum quantity of serum; sinuses distended with dark fluid blood. Lungs dark red; in right many patches of extravasation; sub – pleural and mediastinal cellular tissue presented same appearances; much bloody serum in pleura, and some in pericardium; heart soft, left ventricle empty, right and large veins full of blood, fluid or loosely coagulated. Liver enlarged, fatty, and perfectly bloodless, as also was spleen. In stomach much thick mucus adhering to lining membrane, but no inflammation here or in other parts of alimentary tract. Some sub – peritoneal ecchymosis on intestines. Cortical substance of kidneys was granular; Malpighian corpuscles showed as red points; on microscopic examination rate mirabile was found injected, and uriniferous tubules blocked up with exudation matter. Mucous membrane of pelvis of kidneys showed some ecchymosis. Bladder contained a little cloudy urine. (NITSCHE, Amer. Journ. of Medorrhinum Sc., Jan., 1858.)
13a. MARIE S -, aet. 31, servant, muscular and robust, entered hospital Jan. 21st, 1859. On previous day she steeped two boxes of matches in hot water for an hour, and drank the liquid at 6 p. m. after stirring it. In 1/2 hour acute pain behind sternum and in epigastrium. Towards 8, several vomitings of food, phosphorescent. By 11 pains had spread all over abdomen. Towards m., vomiting containing blood. She was given magnesia in water. At 9 a. m. her state was as follows: – Breath alliaceous; no buccal lesions; pain behind sternum; acute pain – both spontaneous and on pressure – in whole abdomen (which was distended), but especially at umbilical region; frequent desire to micturate, and pain in act; pulse 72, feeble. Face is little altered; patient only seems fatigued. Some tepid water with white of egg caused several vomitings containing a little blood. 22nd. – Odour gone from breath, dysuria and vomiting ceased, several stools (she had had a purgative enema). 24th. – A vomiting without blood – tinge, a semi – liquid black stool, rectal tenesmus; constant abdominal pains. (Cupping and poultices.) 25th. – No vomiting; otherwise same. 26th. – Constant rectal tenesmus; liquid bloody stools; vomiting of nearly pure blood, of dark colour. Liver is felt slightly beyond false ribs, tender on pressure; heart – sounds distant and full, its beat feeble, but not abnormal; brain quite clear, but patient feels very weak. (Stimulants and astringents.) On the following days patient’s condition seemed to improve; abdomen remained large, but less tense; no more vomiting; rectal tenesmus less; abdominal pains had much diminished, save for an occasional colic preceding a stool containing a little blood. She had grown thin, and was weak, but not prostrate. She now stated that she was pregnant, and had seen nothing since November. Cervix uteri was accordingly found soft and closed. There had been no blood from the vagina; nothing, therefore, to make one dread a miscarriage. Feb. 9th. – Reappearance of blood in stools. 11th. – Vomiting, or rather regurgitation without effort of nearly pure blood; very abundant epistaxis, and hemorrhage from both ears – blood from all being very fluid and coagulating with difficulty. On the following days patient still threw off a little blood by the mouth, and there was always some in the stools. 14th. – Urine now tinged with blood. (Ice and cold affusions.) With return of haemorrhages nervous phenomena appeared – at first, pain and numbness in left arm, then in other limbs, cardiac pains, constriction of throat, and stifled feeling. 16th. – Vesical tenesmus; pains in kidneys and hypogastrium; always blood in stools, and sometimes nothing else (very fluid); still blood in urine, and occasionally in sputa. 17th. – To – day a slight yellowness appeared on face and limbs (not in sclerotics), and on the following days became more pronounced; urine was not icteric, and haemorrhages nearly disappeared. On 27th, however, they returned – with stool and urine, and from nose. By March 1st patient was much weakened, lay spine, voice nearly extinct, eyes half closed, lips white; pulse 70, very feeble, extremities cold. Haemorrhages now diminished again to complete cessation on 6th, but returned on 10th through all channels. From 12th to 15th they subsided a new; and patient, less weakened this time, desired to leave hospital.
13b. While away her health was fairly good, save that she was weak and easily fatigued, and had neuralgic pains in her limbs. The vesical tenesmus had departed, but left in its place some incontinence of urine, especially while walking. On 30th blood reappeared in urine rather freely, and on April 1st she returned to hospital. On that day there was copious vomiting of blood; but it did not recur, and no fresh loss occurred save (upto 8th) a slight one by the kidneys. On 28th she left again in a fairly satisfactory state, save for some anaemia; incontinence and neuralgic pains had disappeared. She subsequently had copious uterine haemorrhage early in July, but went on to full term, and was delivered without accident. She had scarcely recovered, however, when she was seized with diarrhoea – not sanguineous, which nothing would arrest, and she died in September. At the autopsy nothing was found amiss but a slate – coloured appearance of the intestinal mucous membrane. (TARDIEU, op. cit.)
14. Both the symptomatology and also the processes of the deleterious action of Ph. have been defined through the great activity of a large number of meritorious investigators, who have proved that by it sooner or later a fatty degeneration of the liver, kidneys, stomach, and heart, of the voluntary somatic muscles, of the non – striated fibres of the muscular tissue of the intestines, and even of the parenchyma of the lungs, is brought about, and that numerous sanguineous extravasation are found throughout the body. I have examined a considerable number of cases of acute poisoning with Ph., and should like to give a prominent place to the fact that it is not only the central organ of the circulatory apparatus that is involved in the fatty degeneration, but also the peripheral parts off the arterial system, even as far as the minute microscopic vessels. This can be observed in all the organs, but most easily in the brain, in cartilage, in the marrow of the bones, and in the liver. The principal symptoms of it are the sanguineous extravasations. When in a woman the poisoning occurs just before the menstrual periods, the physiological hyperaemia of the sexual organs strains the parietes of the vessels, which are lowered in their power of resistance by the fatty metamorphosis, and the haemorrhages become more severe, often so severe that general anaemia is a consequence. The blood from the uterine walls escaping, we find at the autopsy only a more positively haemorrhagic condition of the lining mucous membrane. It is, however, different in the ovaries. Here real blood tumours are formed, and as probably the haemorrhage does not occur all at once, but gradually, these at first remain within the ovary, gradually enlarging its circumference; not until later are they voided, either into the peritoneal cavity or – when adhesions have been formed – into the rectum. The process attains its maximum when highly vascularised connective tissue has been formed about the uterus in consequence of a pre – existing perimetritis; then the haemorrhage is not only into the ovary, but also from the numerous thin – walled and now fatty degenerated vessels of the new tissue. In 1870 I had an opportunity of bringing before the Berlin Obstetrical Society 4 cases of poisoning by Ph., and of exhibiting preparations showing haematocoeles of sizes varying from that of a cherry to that of man’s fist. In two of these cases they lay within the ovaries; in one there was a breaking up towards the pelvic cavity; and in the fourth perforation into the rectum had followed. (WEGNER, Virchow’s Archiv, Bd. lv.)
15. a. Marie M -, aet. 34, married, was confined May 25th, 1864. All went well till June 6th, when on account of some domestic troubles she determined to poison herself. She macerated in water for 24 hours the heads of a box – full of matches, and took the solution at 4 p. m., in her haste swallowing also some of the match – heads. There followed immediately acute pain along alimentary tract, but no vomiting or stool. At 8 a medical man who was summoned ordered an emetic, which acted freely upwards and downwards; and this went on during n., with some relief to the gastro – intestinal pains. On 17th, m., she had profuse epistaxis. She was taken to hospital, where M. Vernay saw her at 4 p. m. General condition seemed to have been good, and mind was unimpaired. Bad taste (as of Ph.) in mouth; sense of burning along throat and gullet; acute pains in abdomen, but especially at epigastrium; belly lax, not distended with gas, but least pressure aggravated pain; no nausea or vomiting since n., one stool in m. Acute frontal headache; she is drowsy, but cannot sleep general bruised feeling; weakness; very distressing sensation of lassitude in arms and legs; neither anaesthesia nor hyperaesthesia. Slight cough, causing a little pain at base of sternum; but no physical signs in chest (or heart). Face pale, anxious; skin moist; pulse soft, compressible, regular, 72. (To drink egg water, and to have a purgative enema.) 18th. – Sleepless but quiet n. To other symptoms is added very sharp pain renal region. No stool. (Castor oil and enemata.) 19th. – A stool on previous evening had calmed somewhat the gastric pains. Headache constant; insomnia; pains in legs; no fever. (Same, and milk with magnesia.) 20th. – Sleep restless; colicky pains, and those in renal region very acute; headache, nausea, very painful sense of lassitude. 21st. – Last n. free evacuations upwards and downwards, which have much diminished the colic; but headache persists, and she had during n. two very painful and long lasting cramps in calves. (Stop magnesia.) 22nd. – A little better; complains only of headache and some renal and epigastric pains; limbs, especially legs, feel bruised. (Rice soup.) 23rd. – Pains worse; nausea; nervous twinges, which she attributes to emptiness. (Chicken.) 24th. – Had yesterday a slight haematemesis, which has relieved her; prostration more marked; sharp pains in epigastrium and kidneys; headache; more pain in limbs. (Perchloride of iron.) 23rd. – Catamenia appeared slightly yesterday; blood pale. Colic sharper, nausea, diarrhoea with blood. For first time liver tender on pressure; does not seem enlarged. Urine scanty and albuminous. Headache less, but pains in limbs – especially legs – worse; patient feels as if something were gnawing the bones. Sensibility intact; no fever. 26th. – Vomited this m. 100 grms. of pure blood, was relieved but weakened thereby; legs more painful, she can scarcely stand upright; stools always copious and bloody. (Continue iron.) 27th. – A fresh haematemesis this m., like that of yesterday; sharp colic, numerous bloody stools with tenesmus; pain in liver and kidneys (especially r.) more acute; no jaundice; increased prostration. 28th. – Blood from stomach and bowels, and with urine; greater hepatic and renal pains. 29th. – Enterorrhagia with very painful tenesmus; weakness more marked. 30th. – Same; more haematuria; slight pain in eyes, feeling as of sand below upper lids, vision somewhat troubled, conjunctivae of a dead white, pupils normal. July 1st – 3rd. – Same; anaemia very pronounced; pulse sphygmographically normal. 4th. – Yesterday evening somewhat copious haematemesis; in n. 3 very painful cramps in legs; headache sleeplessness; great weakness; blood with stools and urine; a slight icteric tint over surface. 5th. – Same state; sight much affected, with dazzling, cannot see to thread a needle. 11th. – Sanguineous diarrhoea has ceased, and is replaced by constipation, but colic persists, as also hepatic and renal pain; copious haematuria; pains in legs; icteric tint more pronounced. 17th. – Some improvement; appetite and strength better; otherwise as on 11th. 21st. – Urine always very scanty and bloody, and its emission accompanied with acute pains in kidneys; till this m. she had passed no urine for 2 day 25th. – General condition, including sight, now very fair, but urinary symptoms continue; liver is render to pressure, and skin is decidedly icteric.
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.