27. A. Tission, aet. 50, a worker in a lead manufactory for 4 months, began soon to suffer from colic, for which he was admitted into the hospital. On being discharged he returned to work where he was less exposed to lead influences, but after 5 days he began to suffer from sharp pains in the joints, and was readmitted Feb. 21st, 1875. Very acute pains for now 15 day in many joints; the most painful are those of the lumbar spine and shoulders, but all are more or less affected except in jaw, fingers, and toes. Little felt when at rest, the least movement excites them; pressing the surfaces of the joints together causes severe pain; pressure round the joints less felt. The muscles are free from pain; no redness or swelling. Sleep generally good, but the sometimes wakes with starts; he also wakes when he moves; he has nightmare nearly every n., he thinks he is pursued by assassins and cannot escape. Continued headache and frequent vertigo for 15 d. He feels weakness in all his limbs; buzzing in ears; he sees showers of snow or of fire; he nearly loses consciousness, and must get hold of something to prevent himself falling. These attacks occur two or three times in the 24 hours; they are followed by very severe headache. Weakness of right hand; he can extend the ring and little finger very much less than the others; it is with great difficulty he can lift a chair with his right hand; the left is not so much weakened. Sense of numbness and formication in fingers, especially of right hand, which is followed by painful prickings. No loss of sensibility in legs, but right is weaker than l. Anaesthesia and analgesia of all right upper extremity; skin can be pierced with a needle without causing pain. Pupils equal and contractile; tongue clean and moist; bowels costive; pulse regular, 64; urine normal, no albumen. 23rd. – One vertiginous attack yesterday; increase of paralysis of extensors of right hand; still the anaesthesia, extending as high as insertion of deltoid. Sensibility less in right lower extremity than in l., but no anaesthesia: the sensibility of each side of trunk is equal. Sight of right eye feebler than that of l; is unable to read with right alone; no diplopia. Hearing of right ear less than that of l. The articular pains are as strong on one side on other. March 2nd. – No vertigo for 4 day; constant headache. Sleep good but for nightmare; pains in articulations still great, no myalgia: the paralysis is less. The report ceases at the date. (Ibid., p. 175.)
28. J. Clarke, aet. 30, was admitted in a state of profound epileptic coma; and from Oct. 18th to 20th he had five convulsive fits, accompanied and followed by coma, which continued for 2 day, when he began to recover. I viewed the case then as one of those in which the cerebral affection was due to the presence of some irritating matter in the blood which ought to be eliminated by the kidneys. There are very good grounds for believing that when urea is retained in the blood, the brain is very likely to be affected so as to cause coma and convulsions. As soon as recovery from the state of coma took place, we observed a paralytic affection of the upper extremities, and of these alone; the legs were in no way involved. Nor did the paralysis involve all the muscles of the upper extremities; those of the arm and shoulder were only very slightly affected; the muscles of the forearm were chiefly engaged, and of these the extensors were most distinctly paralysed. All were wasted; but the extensors most so, as was obvious from the hollow which existed over those muscles on the back of the forearm. His power to flex the wrist and grasp with his fingers was very feeble, but he was wholly unable to extend the wrist or fingers. When the arm was stretched out from the trunk, the hand hung, as if lifeless, from its articulation at the wrist. Both upper extremities were affected in precisely the same way, although not precisely to the same degree; for the right forearm was evidently weaker than the l. The muscles which form the prominence of the ball of the thumb (the thenar eminence of anatomists) were also paralysed and greatly wasted, and the power, of flexion, or extension, or adduction of the thumb was almost entirely destroyed. He was admitted on the 18th of Oct.; on the 22nd he was quite free from any comatose symptoms, and there now remained to be dealt with the condition of the kidney (the fons et origo of the cerebral disturbance) and the paralytic state. The urine had increased considerably in quantity; it was still, however, very highly albuminous, becoming almost solid by heat, and of low specific gravity; and, under the microscope, contained casts of tubes and epithelium, and some blood – corpuscles. He exhibits precisely the character of that form of palsy which results from lead – poisoning, more commonly known as the ‘painters’ wrist – drop. ‘ All the characteristic signs of this form of palsy were as well marked in this case as in any case I have ever seen. When you make him hold out his arms, you see both hands hang down, and he has no power to bring them to the state of extension. A practical man could not see such a case without asking if the patient was a house – painter. Yet we found, on inquiry, that not only was he not of that trade, but that his proper vocation, that of a waiter, did not particularly expose him to the lead contamination…. It appears that a part of our patient’s duty was to clean and keep bright the pewter pots belonging to the public – house to which he was attacked. This he did by friction with his hands. Now, pewter very commonly contains lead in considerable quantity, and no doubt the frequent contact of this with his hands would lead to a gradual absorption of a sufficient quantity of the metal to produce the poisonous effects; or the repeated friction might cause the separation of minute metallic particles, which might be inhaled. (TODD, Clin. Lect., 1856.)
29. a. A man, aet, 21, admitted September 5th, 1875, into the hospital, complained of the usual symptoms of lead – poisoning, headache, constipation, vomiting, pain in abdomen; on his gums a well – marked line. He stated that he had worked seven years in a lead factory, and had many previous attacks of colic, but that otherwise he had been a healthy man. He was anaemic, and complained more than usual of headache; indeed, that was his most urgent trouble. His discs were examined, and it was found that he had well – marked optic neuritis, his discs having an opaque, white, glistening appearance, the opacity concealing portions of the large vessels and the margin of the disc. This material extended with an irregular and somewhat abrupt outline into the adjoining retina. Both arteries and veins were larger than normal, but no haemorrhages were seen. On the day of admission he was very dull and stupid. and on th day following he was delirious and had a convulsive attack followed by coma; some days later more attacks with great complaint of acute pains in the head. He died on September 20th. Contrary to what is usually seen in cases of optic neuritis which come under the physician, this man was quite blind.
29b. At the autopsy the brain was carefully examined, but no abnormal naked – eye changes were found. Portions of brain were analysed by Dr. Tidy, who found in each portion examined an appreciable quantity of lead. He calculated that the brain, supposing the lead to have been equally disseminated throughout it, would contain at least 5 gr. of that metal. The kidneys were healthy. (Lancet, 1878, i, 784.)
30. In professional intoxication with lead, the number of the red corpuscles of the blood is much reduced, even by one half. This hypoglobulia is the more marked as the workmen are more exposed to the lead dust, as they have been long engaged in their occupation, and as their age is advanced. It is least in the arthralgic, most among the paralytic, very variable among the enteralgic subjects. It is not appreciably improved by the dispersion of the acute attacks; in a patient not exposed to any fresh poisoning it existed still 3 mos. later. There is no hydraemia. (MALASSEZ, Arch. de Phys. 1874.)
31. Dr. CARSON has observed that house – painters and others, with either paralysis or great muscular debility from lead – poisoning, had uniformly a more or less weakened impulse of the heart, and generally, on going upstairs, complained of some faintness and cardiac distress. These heart symptoms were absent in the earlier stage when lead colic only existed. He gives 10 well – marked cases where the poisoning had produced paralysis of the extremities, and where much alarm was excited by the great feebleness of the heart, with palpitation, consequent fainting, weak and soft pulse. He regards its cardiac action as similar to that of digitalis, tobacco, up as antiar, woorara, tending specially to paralysis of that organs. (N. Y. Journ of Medorrhinum, 1856, p. 325.)
32. According to DUROSIEZ, the cardiac sounds are at first purely chlorotic, then after a time in a certain number of cases the sounds are reduplicate, becoming rough and blowing. As cure takes place this course is reversed, the rough murmurs disappear and become chlorotic, and these in time may cease. He has noticed that the femoral artery is sometimes the seat of a double intermitting bellows sound. This was noticeable in the case of a house – painter, aged 21, who had for seven years been in contact with lead; there was slight hypertrophy, the sounds reduplicate, the second sound was rough and altered, almost like pericardial friction sounds. He considers that stethoscopic examination most generally indicates disease of the aortic valves. (Gaz. des Hopitaux. 1869, p. 565.) [ Addison reports a case under his care in Guy’s Hospital, of a pale exsanguined man, who had long suffered from heart symptoms, chiefly palpitation, and failing power of the limbs. At first this patient was supposed to be suffering from cerebral mischief consequent on cardiac disease, but a later examination of the case showed ]
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.