22b. Autopsy. – Absence of oedema or anasarca. The metatarso – phalangeal articulations are lined with numerous whitish deposits of urate of soda. Articulations of big toes have their cartilages and ligaments encrusted with abundant deposits of same salt. Very fine deposits seen finger – joints. Extensors of the finger, extensor proper of little finger and index, long abductor and short extensor of thumb, are pale, yellowish, and atrophied. The other muscles of forearm are healthy. Microscopic examination of the atrophied muscles shows a great number of the primitive fibres much diminished in volume but retaining their striae: at some points the muscular fibres present only the sarcolemma, showing in its thickness nodules which are more numerous in proportion to the atrophy. The branches of the radial nerve show gradual degeneration of their myeline. Brain spinal cord are normal. Lungs show old adhesions; bronchial glands are enlarged. Heart shows patches of fat on its anterior surface and sides; large milky – looking patches at root aorta and on anterior surface of auricles. left ventricle is firm, red, and considerably hypertrophied. Mitral orifice is normal, but aortic is insufficient owing to thickness and adhesion of the valves. Internal surface of the aorta is covered with atheromatous patches; carotids and some of cerebral arteries are similarly affected. Kidneys are atrophied, reduced one half in size, granular, affected by interstitial nephritis. Stomach presents the appearance of uraemic gastritis. It is enlarged. Liver and pancreas are normal. (E. LANCEREAUX, Mem. Soc. de Biologie, t. ii, 5e serie, 1870.)
23. A painter, aet. 35, had colic when 25; 10 years ago, after the first attack of colic, the sight became affected. For 3 years he has complained of malaise; constant pain in limbs; intense occipital headache, coming on in paroxysms; suborbital neuralgia, occasional; the urine is albuminous. The slight, especially in right eye, has been gradually getting weaker, during the last 7 weeks this diminution of vision has prevented him working. He looks ill and thin; there is no oedema. Muscae volitantes, circles of fire, difficult to see object in evening, impossible to read; these symptoms worse in right eye; pupils dilated, especially r. Ophthalmoscope shows – in left eye localised granular degeneration, exudate making the papilla and exit of vessels; right eye, degeneration more limited, but exudates more numerous, masking the vessels in a great part of their course. (L. DANJOY, Arch. gen. de Medorrhinum, 1864, i, 402.)
24. M. ZULMA, aet. 37, was admitted 22nd May, 1872, under M. Vulpian’s care. The father died at 55, probably of alcoholism, the mother at 58, of paralysis. The patient has been a house – painter since he was 17, and enjoyed good health until 6 years ago, when he had violent colic, followed in about 10 days by paralysis of hands, cramps in hands, and wandering pains in body. He had a second attack 4 years ago; the following years another, and his 4th a year after. His 5th attack commenced 15 days ago, the colicky pains very severe, with increase of paralysis. On admission the pains are slight; thirst, white tongue, no appetite, constipation, no fever. He complains of cramps and continued pains in all the limbs, especially in deltoid region. Extensors of forearm are completely palsied; slight trembling of hands. Electric sensibility has disappeared. Breathing normal, but complaint is made of slight pain in region of diaphragm on inspiring. Strong palpitations of heart, slight blowing murmur with first sound towards apex. Sensibility not affected. Decided albuminuria. The patient presents a marked yellow cachectic look, and blue line on gums. He was treated by electro – magnetic currents and iodide of potassium, which were continued up to June, 1873. In July, not feeling well, he kept his bed for a new day, and on getting up on the 10th he complained of confusion, and stumbled against things. At 11 a. m. he was seized in bed with a severe epileptic attack; no aura, marked cry; tetanic stiffness of neck and limbs; complete loss of consciousness; respiration ceases for a moment; face purple, with congested spots on forehead and face; convulsions of muscles of face; slight clonic convulsions; foaming at mouth, tinged with blood. This condition lasted 3 m.; the limbs then relaxed, and after 1/2 hours of coma and torturous breathing semi – consciousness returned, but with great drowsiness. During day 2 more attacks, but less severe. Urine contains much albumen. The administration of iodide of potassium renewed. July 11th. – He looks exhausted and is drowsy; he makes no complaint of pain; the vision is very indistinct, he distinguishes nothing; remembers nothing of yesterday. 12th. – Still marked albuminuria; the intelligence returned, and vision restored; he complains of distressing pulsations in the temples; action of heart rapid and vigorous; pains in both shoulders. 14th. – The albuminuria has nearly disappeared, abundant deposits of urates and uric acid; strong traces of iodide of potassium. 22nd. – General state of health good. Electric appliances were used up to March, 1874, when he left much improved. It is to be remarked that 2 years after having ceased to work with lead, and though so long under the influence of iodide of potassium, he was attacked with epilepsy. (RENAUT, Intoxication saturnine chronique, 1875, p. 156.)
25. J. DUMONT, aet 46, worker for 18 years in white – lead, was first treated at La Pitie, May, 1871, for lead colic. He was readmitted March 4th, 1874, suffering from severe colic. He had given up working in lead since 1871 owing to frequent attacks of colic; he had, however, resumed this work 6 weeks previously. He has never suffered from cerebral disease or paralysis; he is temperate; and he is not syphilitic. For the last 15 days he has been feeling sense of weakness in right side; he is not intelligent, but answers questions distinctly. He has frequent headache; slightly deaf on right side. All the right side of face is affected by marked anaesthesia; insensibility to touch, to temperature, but especially to pain. The facial hemiplegia is not very evident. The arch of the palate is insensible to touch, the uvula is drawn to the l., the muscles act indifferently, and reflex movements are not excited; deglutition is impaired. The tongue is strongly diverted to the l., and bent to same side. The voice is nasal, and words are not pronounced distinctly. Blue line on gums is very marked. The motility of the right upper extremity is diminished, and there is a certain amount of atrophy of the posterior muscles of the forearm. The extension of right wrist is more difficult than of l.; the sensibility over the extensors is destroyed, as regards touch, temperature, and pain. Walking is difficult, he drags the right limb, and on examining him in bed the weakness of this leg as compared with the left is evident. The toe of right foot are contracted like claws. Complete anaesthesia and analgesia of right limb; these conditions extend up right side of abdomen, of loins, and of thorax, keeping to right of median line anteriorly and posteriorly. A prick gives the sensation of rubbing, and a pinch that of simple touch. The umbilical region is painful to touch; constipation for 8 d. Blowing murmur very marked in vessels of neck; urine normal. He was treated with strychnine and iodide of potassium; up to May 10th there was no appreciable change; electric contractility is much diminished in right compared with left side; this is especially evident in the extensor muscles. June Ist. – He has gained strength and walks much better, the right leg now shows hardly any trace of dragging. In 6 months all the symptoms had almost entirely ceased. Raymond remarks on this case that the diagnosis lead paralysis was indisputable. There was no question of hysteria; the paralysis came on slowly without any precursory symptoms, no apoplectic attack; the electric sensibility disappeared in the paralysed limbs; and, contrary to what occurs after cerebral haemorrhage, the limbs were irregularly affected and the groups of muscles unequally palsied. It reminds him of similar symptoms in another lead case, where the signs of paralysis (sensibility and motility) were more marked on one side than the other, loss of hearing, smell, taste, &c (Ibid., p. 166.)
26. left 1 -, aet. 46, of a healthy family, has worked for 3 months in a lead manufactory at Clichy; towards the end of this period he had severe attacks of colic. A few days after this he was seized, on March 23rd, with a marked encephalopathy; while washing his hands he fell down insensible, he then had convulsive movements; this attack lasted 2 h. Five days after he had another similar attack which lasted an h. He then ceased working in lead. About April 2nd he remarked that he could not use his hands when he wished to eat; if he attempted to lift a glass to his mouth his arm shook so that he was unable to drink. Next day he experienced slight formication in the lower extremities, and in 4 day he walked with difficulty, was obliged to lean on something to avoid falling; he also felt sharp one – sided headache, with diminution of slight and hearing, especially in left side. As the legs became worse the lack of co – ordination in the arms diminished. He was admitted into the hospital April 8th; he had enjoyed fair health previously to working in lead; had not suffered from syphilis or alcoholism. Marked blue lines on gums. Violent left – sided headache, with nocturnal exacerbations. Slight anaesthesia of left side of face, otherwise face normal; l. pupil is more dilated than r.: slight deafness of left ear, with buzzing noises. Considerable loss of muscular power in arms, especially l.; no apparent atrophy. Pressure on last cervical and first dorsal vertebrae excites pain; no hyperaesthesia. There is marked loss of co – ordination of both arms, especially of l.: the patient cannot, on closing the eyes, carry hand to a point in face without feeling the way. Analgesia of both arms. In lower extremities marked incoordination; when he wishes to make a movement it is executed with difficulty; on shutting his eyes and trying to walk he strikes his heel against the ground, he trembles, and would fall were not some one at his side. There are painful zones over the articulations of the neck, the knees, and the feet; anaesthesia to touch, to temperature and to pain over both limbs, especially l. Increased reflex excitability, especially of left side. Iodide of potassium; sulphur baths twice a week. The symptoms continued much the same, the headache though persistent was loss severe until April 18th, when walking was easier, but still trembling and the want of co – ordination. April 20th. – Pain and swelling over wrist and back of left hand: the ring and middle finger are bent, to extend them causes pain. 26th. – The swelling of wrist is confined to the tendons of the flexors; the skin is red, and very painful to the touch. [M. Gubler has pointed out an unusual variety of deformity and lesion of tendons, which he has observed in two patients suffering from lead-poisoning. This lesion consists in a sort of plastic and fungoid synovitis, seated in the sheath of the extensors on the dorsal surface of the hands. Legros who examined the second patient, recognised necrosis of the primitive tendon sheathed in a tendinous tissue of new formation. M. Gubler has seen a similar condition in paralysis a frigore, in a coachman suffering from the effects of cold rain falling on the hands. (Brit. Medorrhinum fourn., 1873, ii, 841.] The power of movement and co – ordination improved. May 26th. – He walked well, and showed no loss of co – ordination; he left the hospital on the 29th of June almost completely cured; it would have been difficult to trace any remains of the symptoms for which he had been admitted. (Ibid., p.170.)
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.