19a. A man, aet. 30, who from a boy had worked among preparations of lead, was admitted to the Vienna General Hospital the end of March, 1840. He had 10 attacks of lead colic, the last 10 years ago. Two months ago was attacked by repeated violent headaches and vomiting, afterwards by marked dimness of sight and great weakness of lower extremities, and for the last few days has had oedematous swelling of face and feet, anorexia, pressure on chest, and dry cough. The headache was in the occiput, often extending to forehead; objects appeared to him as in a fog; pupils contracted, sclerotic leaden coloured; taste like clay, great thirst, gums spongy, swollen, teeth dirty grey; breathing often interrupted by sighing; abdomen fallen in; pulse small, slow; frequent vomiting of greenish – grey matter. After a few day considerable swelling of face, especially of eyelids and abdomen; frequent headache commencing in occiput, and accompanied by bilious vomiting; dry cough on taking a deep breath; serous infiltration of almost all the skin; during the vomiting great pain in umbilical region, pains much increased by pressure. He often fell into a soporous state; eyes dull, voice scarcely audible. After a few more day staring look, vision dim, eyes projecting, features sunken, extremities convulsively agitated, eyelids extremely swollen and sensitive, conjunctiva of left eye much suffused with blood; respiration rapid, anxious; epigastrium very tender, frequent vomiting of green matter, frequent copious epistaxis, nocturnal delirium alternating with sopor, frequent cough with bloody expectoration, great debility, voice hardly audible, great pain in extremities, dryness of mouth, meteorism. After a time the anxiety increased, as also the difficulty of breathing, often to fear of suffocation. He could only breathe in a squating position; every part of the skin, especially of the arms and eyelids, very sensitive to the slightest touch; he sometimes lay quite apathetic, complaining of nothing and somnolent, and at length died after being moribund for 24 hours on the 26th April.
19b. P. M. – Skull long – shaped, its bones compact, in the sinuses a little fluid blood, the inner membranes much thickened, opaque, filled with much grey serum, devoid of blood; cerebral substance pale, soft, bloodless, in the central cerebral cavities 3 drachms of brown clear serum; vascular plexuses pale, pineal gland soft, not gritty; in base of brain 1/2 oz. of clear serum. Thyroid gland pale, tough; in trachea much fluid mixed with mucous flakes, m. m. pale; both lungs pale, tough, bloodless; in the pleural, cavities several pints of brown serum mixed with fine lymph – flakes, in pericardium 2 pounds of dark brown serum; the serous investing membrane of pericardium and heart covered with a layer of greyish – red, fine villous, firm exudation of lymph in meshes; the heart more than twice the normal size, the wall of the left ventricle more than 1 inch thick, pale brown, firm valves normal; in the auricles, besides form pale lymph, much blackish – red coagulated and fluid blood. Liver brownish red, soft; bright yellow, fluid bile in gall – bladder; spleen swollen, pancreas soft, stomach contracted, containing a little brown opaque fluid, its m. m. very corrugated, thick, tough; intestines very contracted, grey, yellowish, containing faeces adherent to their walls; mesenteric glands soft; both kidneys diminished to half their size, the surface of their cortical parts studded with prominent granulations of the size of hemp – seeds and larger, dirty yellowish – white, very firm, tough, and between them blackish blue deposits like pigment, and among them single cysts the size of peas containing brown serum; bladder contracted, containing a few drops of opaque urine. In the peritoneal cavity 6 pounds of grey serum. (BEER, Oester. med. Wochenschr., No. 35, p. 817, 1841, in Frank’s Mag., i. 799.)
20. A journeyman painter, aet. 24, who had formerly had 3 attacks of colic saturnine came into hospital for 4th attack. For 4 months had noticed weakness of hands, which now amounted to complete paresis, so that he could not feed himself. The weakness also affected lower extremities, so that his gait was uncertain and staggering. Stools very costive and scanty. Since 7 days pains in umbilical region and lower extremities, and obstinate constipation. Abdomen hard and tense, umbilical region drawn in, with tearing pains, and very sensitive to pressure. Tearing pains in lower extremities. Urine dark coloured and turbid; strong fever, pulse 110, large and tense. He got 6 oz. of quicksilver, followed by enemata and castor oil, which brought away much faeces, but the quicksilver did not come away till after the lapse of 3 d. He then recovered, but the paresis of the hands remained.
(KNAPP, Rust’s Mag., lx, hours 2, 298, in Frank’s Mag., i 604.)
21a. A. Duhamel, aet. 56, a house – painter for 40 years, of middle height, born of healthy parents, was admitted into La Charite, Paris, 14th Aug., 1863. Every 2 or 3 years he has had attacks of colic, the last being in June; otherwise he has been in good health. Present condition – trembling of voice (for now 12 years); the colic have nearly disappeared; characteristic blue line; slight diarrhoea; abdomen is soft, and not painful to pressure. The hands tremble a little when extended; paralysis of extensor muscles. Marked loss of muscular power of both arms, sensation intact; pains in knees and ankles, without swelling or redness; occasional cramps. No trace of oedema. Heart and lungs normal; special senses intact. Skin dry, cool; pulse 80, regular, full. The urine pale, and contains much albumen and a considerable number of renal cells; lead found in the urine. 17th. – Same condition of urine and other symptoms; pulse 96. 24th. – Complains of weakness; the urine is hazy when treated by heat and nitric acid, but gives no deposit. Sept. 2nd. – The paralysis of extensors is less marked; the urine still albuminous; the patient, feeling better, wishes to leave. He resumed his work for 16 day, but the return of colic and increase of paralysis obliged him to desist, and he re – entered the hospital Sept. 28th. He looks very pale; extreme emaciation; sharp colic and constipation; paralysis of extensors of arm, forearm, and hands, great weakness of lower limbs. Embarrassment of speech, trembling of tongue, twitchings of muscles. Intelligence and sensibility not affected. Pulse 120, small; respirations, quick; nothing abnormal in heart or lungs. The urine very albuminous. 29th. – Pleased a delirious night, but is now calm; symptoms as before; spleen normal, but liver retracted. Urine very albuminous, containing numerous casts. At 9:30 p. m. he took soup; at 10 he attempted to leave his bed to go to the closet, and suddenly expired after crying out, “I am dying,” and making half a dozen noisy inspirations; the tongue projected from the mouth.
21b. Autopsy made 28 hours after death. Very marked rigor mortis. Head. – Sinuses of dura mater gorged with blood; absence of serosity in arachnoid; membranes of pia mater congested. The lens shows congested capillaries on periphery of brain and cerebellum, and minute extravasations of blood. Arteries at base of brain and cerebellum give negative results. Thorax. – Nothing in lungs to report. Heart has no blood on right side; aortic valves healthy, mitral a little thickened and rough at their base. Kidneys. – Notably diminished in size; numerous granulations on surface, colour yellowish, the cortical substance opaque. Microscopic examination found the alterations present in Bright’s disease arrived at the stage of atrophy of the cortical substance. (OLLIVER, Albvm. saturn., 1864.)
22a. L -, aet 43, a house – painter since he was 8, had at 15 his first attack of colic, since then he has had five. About 4 years ago he was attacked with paralysis of extensors of forearm; this has never wholly disappeared. When 37 he was suddenly seized with acutely painful swelling of left big toe; this disappeared in 8 day, and was replaced by similar affection of right toe. He had three similar attacks since, the last Aug., 1869; this was not confined to the big toes, but affected also the tibio – tarsal articulations, heels, and finger – joints. This attack lasted about a mouth, and the feet were swollen during that time. He then returned to his work, which in November he was forced to quit owing to palpitations and oppressed breathing, especially on going upstairs. He was admitted into La Charite, Jan 5th, 1870. The skin is of a distinct yellow colour, lips livid; face very slightly swollen, but there has never been oedema of the limbs. Paralysis of extensors of both forearms; if he raises wrist he cannot without great difficulty extend fingers. Breathing oppressed, respiratory sounds normal; pulsations of heart strong, sounds normal. Urine pale, almost without colour, albuminous; has never noticed deposits of uric acid. His father died, asthmatic, aet. 56; one sister died from chronic pulmonary disease. (Pot. brom., sulphur baths.) 10th. – Mucous vomiting, in evening vomiting of food; constipation, headache, drowsiness; vision cloudily. Urine a little over two pints; sp. gr. 1010. (01. ricini.) From 10th to 22nd vomiting of bilious matter and food continued. On 24th sudden loss of consciousness, followed by convulsions of muscles of face and limbs, with foaming at mouth, leaving swelling and congestion of the face. Seen in forenoon, his features are swollen, dull look, speech embarrassed, head heavy. He complained of violent one – sided headache, like migraine, which he has been subject to for a year. Slight epistaxis; pulse 100, strong and vibrating, cardiac impulse strong; vomiting, obstinate constipation. Urine becoming very hazy on addition of nitric acid; this disappears on adding an excess of acid, and a reddish colour appears; no sugar. Microscopic examination shows a few hyaline granular cylinder casts, and phosphate of lime; about a quart of urine passed daily. This state and recurrence of frequent epileptic convulsions continued until Feb. 6th, when deafness and great diminution of sensibility were present; the speech is laboured; sleeps very heavily, with snoring. Urine reduced to a pint, pulse 84. On the 9th the symptoms increased, a small quantity of urine passed in bed. On the 10th epistaxis, involuntary motions, urine still albuminous; the patient rises up without knowing what he is doing, at other times he is drowsy: during n. of 11th coma increased, and he died suddenly at 6 a. m. without the slightest movement.
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.