33. In persons exposed to lead influences the pulse is small, thready, soft, and easily compressed. plus [The sphygmograph indicates tricrotic, even polycrotic pulsation. This tricrotism is due, according to marely, to abnormal ventricular systole, and he views it as characteristic of the action of lead on the heart.] It is never intermittent or quick, except sometimes towards the fatal termination of cerebral disease. With the attacks of colic there is generally a peculiar hardness and vibration of pulse plus [ With this there is increased vascular tension, which pilocarpine relaxes and simultaneously relieves the pain EDS”] with marked diminution of frequency, sometimes falling to 40. This is probably a reflex phenomenon, caused by irritation of the sensory fibres of the splanchnic nerve. (BLACK, in Mat. Medorrhinum Phys. and Applied, vol. i. s. [ The phenomena of lead-poisoning which have been observed since Tanquerel’s time we have given in the excellent summary, contained in a volume too little known, form the pen of our valued and lamented colleague, Dr. Black. EDS.] 34. The difficulty of respiration which sometimes accompanies colic and is described by older writers as metallic asthma, is attributed by Tranquerel to paralysis of the intercostals, and according to him is a very rare affection. A patient by lead paralysis or colic without any previous pulmonary disturbance suddenly feels a great difficulty in raising the ribs; they seem almost immovable. When urged to move them the clavicles are raised and the parietes of the chest follow, but like a fixed mass without action of the intercostal muscles; the action of the diaphragm is increased, the respiration becomes more and more laboured, mucous rales are heard, no expectoration, and gradually the patient dies from asphyxia. With this condition there is sometimes aphonia. This aphonia Tanquerel attributes to paralysis of the laryngeal muscles; and it is a question how far this condition of the larynx contributes to the extreme dyspnoea occurring among lead – workers, and independent of the intercostal paralysis. Grunther, Gurlt and Hertwig have found in horses who have been employed in lead – works, that the recurrent nerve and its terminal ramifications were atrophied, and the dilator muscles of the glottis affected by fatty degeneration. ( Ibid.)
35. RENAUT quotes Lewy as having (1811) contributes some remarks on lead asthma, which is a rare affection, as he met with only 21 cases out of 1186 saturnine poisonings. He divides the cases into acute and chronic. The acute form is seen in those constantly exposed to the dust of lead, especially white – lead; it is characterised by extreme dyspnoea, attended with great anxiety and restlessness, deep inspiration, accompanied by epigastric pains and palpitations. The cough is painful and convulsive; percussion normal; the face pale, and covered with cold sweat; no expectoration. There are frequent intervals of 10 or 15 m. between the short attacks. It is generally accompanied by discharge of nasal mucus, which always contains lead. The attack lasts at least 8 to 12 hours, but may be prolonged to as many d. It resembles very much hay asthma. The chronic form is seen in very confirmed old cachectic cases. It is characterised by dry cough in violent long intermittent paroxysms which wholly prevent sleep. The cough is often attended with dyspnoea, which at last becomes severe, complicated with chronic bronchitis and oedema of the lungs. The autopsy reveals cirrhosis of the lungs, and the presence of lead in the pulmonary tissue. The chronic form is generally attended by cold creeping sensation of the skin and great shivering; no perspiration can be excited. (Ibid.)
36. When lead – poisoning is confirmed the skin assumes a dirty pale yellow colour, which is due to anaemia; it has the characteristic of being fixed, and not affected by any emotion. This colour has been described as that of jaundice, but no bile is present in the blood or in the urine. Tanquerel, who designated it as icterus saturninus, states that this colour has nothing to do with the biliary pigment. He has observed it disappear for a time during severe attacks of colic. There is also, sometimes, in confirmed cases a more decided yellow colour more akin to jaundice. This discoloration affects the sclerotic and stains the internal organs, intestines, brain, &c. It is not a true hepatic icterus, for no bile is present in the urine. The discoloration is due to the breaking up of the colouring matter in the blood, such as is present after the effects of either, chloroform, and phosphorus. It is a hematogenous icterus; it is the choleic icterus of Frerichs, the ictere hemapheique of Gubler. (Ibid.)
37. Of the disturbances of general sensibility the most characteristic is anaesthesia. It is not very common, for Tanquerel in his own experience only met with it in 11 cases. It has also been described by Beau, by Gubler, and by Renaut, who draws his observations from cases treated by Raymond and Vulpian. It is generally confined to the skin, rarely affecting the deeper tissues; it appears with, but more generally follows motor paralysis; sometimes it is present with colic or arthralgia; it rarely exists independent of these affections. It is always partial – that is, it is limited to one portion of the trunk or limbs; it may change its site from day to d. It is never complete, always most marked on the right side. It affects generally the skin of the back of the hand and the extensor aspect of the forearm, the external side of calf, the skin of thorax and abdomen; sometimes it has its seat in the arch of the palate and uvula. On these isolated patches there is not only diminution or loss of tactile sensation (anaesthesia), but there is also diminution of sensibility to pain (analgesia); to temperature (thermanaesthesia), rare; and to tickling (hypopallaesthesia), rare (Gubler). The electric sensibility it also completely lost. Manouvriez, who has minutely investigated this loss of sensation, considers the analgesia as the characteristic change. The insensibility to pricking or burning is almost always complete; it very rarely extends over all the body, generally affects one half, and is most marked on the r. hand or wrist. The attacks rarely last beyond 14 d. They are regarded by Gubler, Rosenstein, and Hitzig as dependent on the contraction of the cutaneous arterioles. Vulpian obtained experimentally the same effect by slowly arresting the circulation of a part: Gubler shows that it disappears for the time after exciting redness by friction, and when sweating is excited the anaesthesia disappears. Renaut is informed by Albert that in his experiments with jaborandi he found the same result in lead cases. But the singular distribution of anaesthesia demands another explanation than the simply vascular one, e.g. Tanquerel describes a case where it affected one half of the hand, the muscles preserving their mobility; Renaut describes three cases under Vulpian where hemianaesthesia was present with hemiplegia. (Ibid.)
38. The occurrence of blindness in lead – poisoning has long been known; in addition to the cursory mention of it by several writers it has been described by Tanquerel, and more accurately discussed by Hirschler and by Meyer. Attention has been especially called, in England, to this affection by the publication of a series of cases by Hutchinson (Oph. Hosp. Rep., vii, 6.) Renaut has divided this affection into three different groups: Ist, where there is no cerebral disease; 2nd, alterations consecutive on lesions of neighbouring organs; 3rd, alterations, dependent on albuminuria.
38a. Inflammation and idiopathic atrophy of the optic nerve. – In this group there is no cerebral disease; it will be best illustrated by the following case. A painter, who had another time had colic, has lately been grinding lead colours without adopting any precaution. For 6 day his slight has been grinding lead colours without adopting any precaution. For 6 day his sight has been diminishing; the pupils are a little dilated; visual acuity, to the l. = 11:00, to the right = 12:20; the field of vision normal to the right, central scotoma badly defined to the l. The papillae are strongly injected, not swollen, they have lost their transparency; their edges are badly defined in the inner portion where a light reddish veil covers them; this opacity scarcely exceeds the limits of the papilla. Arteries of normal diameter, but very tortuous, especially towards the left; veins very difficult to distinguish from the arteries. Blue lines on gums, constipation, greyish colour of the skin. Amelioration of the sight after purgatives and iodide of potassium. This case and another, which Renaut also quotes from Schneller, prove the existence of idiopathic alterations in the papillary portion of the optic nerve. Amaurosis due lead may exist, according to Horner, independent of any inflammation; he believes there is then, from the first, atrophy of the optic nerve, similar to that in drunkards and anaemic subjects.
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.