17. An elder brother of the above came to Dr. v. T – about same time, saying that he had coughed up blood for 3 day, having lost altogether about half a pint. On examination of chest nothing very distinct could be detected, save that respiration was very feeble in both a piece; he had no cough. Three months later, after a day’s rowing, he had a fresh haemoptysis, this time with epistaxis. A distinct though slight dulness was now found in right apex, and he looked rather pale and thin. The poisoned water was at this time stopped, and he rapidly regained his good looks, and had no return of the bleeding. (Ibid.)
18. The effect of lead on those who work in it shows itself under four principal forms – colic, arthralgia, paralysis, and encephalopathy. As regards their relative frequency, it may be said that, out of 14 subjects of the poisoning, 12 will have the colic, 8 the arthralgia, 2 the paralysis, and 1 the cerebral affection. Although they may combine in the same individual, they are distinct and independent affections. They are preceded by a primitive intoxication, whose symptoms are – coloration of the gums; peculiar teste and smell, and odour of the breath; icterus; emaciation; and slowness with feebleness of the circulation. [The first two being effects of the deposits of lead in the mouth, we pass them over here. – EDS] The icterus is, in its highest degree, a dirty or earthy yellow tinct of the skin; when less pronounced, the yellowness is pale or a little ashy. It is most marked on the face, and involves the conjunctiva, where it is combined with a bluish tint. The urine is of a dull yellow, but nitric acid strikes none of the colours indicating the presence of bile – pigment; nor is the lines stained. The faeces show a tawny – yellow tint, very marked. The serum of the blood has a slight yellow reflection, but not one verging on green. After death, this earthy yellowness may be found more or less in all the organs of the body. It is unaffected (during life) by abolition. It sometimes develops very rapidly, as in 10 – 25 day after beginning work, but more commonly months or even years are required. It appears due to an alteration in the blood, and is comparable to the tint induced by syphilis and cancer, and that seen in the malaria cachexia. It is not a real jaundice. The emaciation is general, but most marked on the face, where it gives rise to wrinkles, making its subjects look old and saddened. It runs pari passu with, or comes a little after, the icterus. It is accompanied by some loss of strength. The pulse is small, narrow, soft and compressible; and, less frequently, the pulsations are reduced in frequency from 60 – 70 to 55 – 40.
18a. The saturnine colic may be defined as a neuralgia of the digestive and urinary organs, characterised by intense abdominal pains, which are continuous but become more acute paroxysmally, diminished or at least not materially augmented by pressure, accompanied by hardness and retraction of abdomen, obstinate constipation, vomiting or nausea, flatulent eructations, anorexia, dysuria, slow and hard pulse, agitation, and anxiety. It may be brought on in whatever way lead is introduced into the system, save through the unbroken skin. It is most frequent in summer weather and at the ages 30 – 40. The pain begins in a grumbling manner, with slight development of the concomitant symptoms; then suddenly sets in all its severity. In certain cases, before the manifestation of the colic, the workman from gay becomes morose; his features become sunken rather than shrivelled; all exertion is fatiguing; sleep is fitful and unrefreshing.
The pain is most frequently at the umbilicus, and next at epi – or hypogastrium, but may affect any part of abdomen, pelvis, or thorax. It consists ordinarily in a violent sense of twisting; sometimes it is described as tearing, shooting, burning, boring, or it may be felt only as constriction, or as compression from a supposed weight on the abdomen. It is mostly so severe as to throw the patients into the utmost agitation, and sometimes to render them insensible to all that is around them, slow to respond when addressed, and even tempted to suicide. The paroxysms are more frequent by n, than by d. The constipation – rarely absent or replaced by diarrhoea – is obstinate, in spite of frequent desire for an attempts at stool. Even with drastic purgatives the motions come only in scybala, and scanty. It follows, and does not proceed, the supervention of the pain, which also may last for days after purgation has been effected. Retraction of abdomen appeared in 649 out of 123 was the belly large, and it was never inflated. There is no constant quantitative relation between the retraction and the pain, but they coincide in point of time and of seat. During the paroxysms, both abdominal and intestinal walls feel like muscles in cramp; this may at times be clonic, but is ordinarily tonic. Painful tenesmus is sometimes felt in the rectum; it seems drawn together, and the finger can with difficulty be introduced, on account of the tightness of the sphincter and the narrowing of the calibre of the gut. Nausea is more frequent than vomiting, and nearly always precedes it; the latter is specially apt to occur when the colic is seated in the epigastrium; it is effected with much retching and straining. The vomited matters are of a dirty green colour, a viscous consistence, a foetid odour sui generis, and of extreme bitterness. Flatulence is shown by eructations and borborygmus; little passes from the anus. It sometimes becomes incarcerated, forming a quasi – tumour. Hiccup was observed in 115 cases. The tongue becomes coated white, perhaps yellow at back, and may be larger than normally; more seldom it is red and dry. Toothache is sometimes observed, unconnected with carious teeth (28 cases). There is thirst and loss of appetite – the latter being so far an advantage, as solid food provokes the pains.
When the colic is seated in the hypogastric or renal region, there is nearly always functional disturbance of the urinary organs. Painful contraction may be felt at the neck of the bladder; a sound is passed with difficulty, and micturition – during the paroxysms – can be effected guttatim only, in spite of urgent desire. A biting or hot sensation is often felt in the urethra before, during, or after micturition. Urine is redder than normally; in two cases only was it alkaline. The pains may involve the genital organs – the testicles, generally both, with retraction, which also may affect the penis. In two women affected with the malady the pains were severely felt in the vagina and uterus. None but temporary interference with menstruation has been observed. The genital pains do not necessary coincide with those in the abdomen, and must be regarded as having an independent centre. The chest has pains radiating from the abdomen, and also a sense of constriction around the praecordia quite its own. The mamma in women may undergo a painful contraction during the paroxysms. The respiration is embarrassed by the abdominal contraction when in the epigastrium, but sometimes the diaphragm and thoracic muscles seem themselves in a state of spasm. Some patients experience palpitations; a little nervous cough, which fatigues; and even symptoms analogous to angina pectoris. In one case the pain mounted from epigastrium into chest, and spread right down the arms; the patient then felt palpitations and a very marked stifling sensation. Resp. was 35 – 40. In 51 cases jaundice has supervened upon colic. Pulse is most frequently diminished in frequency, and in more than half the cases observed was also hard. It may intermit or become irregular. In some cases an energetic pulsation of the aorta in the epigastrium has been observed; in 13 instances epistaxis occurred. Temperature is rarely affected, but patients may complain of sensations of cold or heat; they always feel these pains increased by cold.
In 49 cases of uncomplicated lead colic ending in death, and where an autopsy has been made, no lesions of any constancy or significance have been discovered.
b. We give the name of “saturnine arthralgia” to an affection of neuralgic character, which the preparations of lead set up after absorption into the system. It is characterized by sharp pains in the limbs without redness or swelling, not following precisely the course of the nerves; continuous, but becoming more acute by paroxysms; diminished by pressure, increased by movement, accompanied by divers disorders in the motor sphere, as cramps, hardness and tension of the painful parts, &c. These neuralgic pains may likewise show themselves on the trunk, and even in most of the organs of animal life. Arthralgia is the most common result of lead poisoning, after colic; the author has observed 755 cases, in 201 of which it stood alone. It arises under the same circumstances as the colic, which it frequently accompanies. It is generally announced by a feeling of numbness and lassitude in the parts it is about to attack. The pain usually sets in during the n. Its most frequent seat is the lower extremities, then the upper, the loins, the thoracic walls, the back or neck, and the head. It affects by preference the flexor surfaces of the limbs, and the joints (especially the larger ones) rather than the intermediate lengths. Its character is tearing – as under, contusive, or a composition of extremely painful shooting, as sudden and rapid as electric shocks. Patients compare these to needle – thrusts, or even to the boring of gimlet. Some say that they feel as if a live coal were in the painful parts; other complain only of pricking, of disagreeable numbness, a fatigued or bruised feeling, a sort of constriction or irritation; other speak of formication. There are, further, a few who imagine a burning liquid to be coursing through their veins, or that an ice – cold body is touching the parts. There is great agitation during the paroxysmal exacerbations, which commonly last a few m. only, and are most frequent at n. The muscles of the affected part are thrown into painful rigidity and cramp; sometimes they are disturbed by tremblings or shudderings. The heat of bed, but also undue coldness, increases the pain. It may feel superficial or deep, and seems to be seated in skin, muscles, bones, or nerves; when it is felt in several parts of a limb it may have a different character at each. In one case, where the face was its seat, otalgia coexisted.
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.