9. Mrs. W -, aet. 28, of a consumptive family, suffered last winter some time from cough with bloody sputa, and was attacked March 8th with left – sided pleuritis and copious exudation. On account of the continued fever she took for several evening 5 grm. of S. of soda, and still the thermometer in the mornings showed, in ano, 38. I was suddenly called to her on evening of 17th, as she took that afternoon, by mistake, 15 grm. instead of 5. She was unconscious, sometimes delirious; when roused, complained of heat, dyspnoea, and difficulty of hearing. She had not perspired. Temp. in ano 38.4, pulse 120 (d. before with same temp. pulse was only 92), resp. 28; breathing very noisy, so that it could be heard in the street. With anguish in her face she gasped for breath in a half-sitting position, and expelled and inhaled air with the same force. The whole mode of breathing, minus the frequency, reminded one of the panting of a hunting dog. In vain I looked for some objective symptoms for this dyspnoea, as retraction of the chest in the fossa clavicularis or hypochondria. After 1 1/2 hours she felt some what easier (she had vomited); pulse 122; breathing heavy, deep, and with exertion. 18th. – 7 a. m., temp. 37.4, pulse 104, resp. 32. Breathing as yesterday, but less forced; some diarrhoea; complains of great thirst and difficulty of hearing. No sweat. Temp., noon, 38.4; 5:30 p. m., 38.8; breathing still panting. 19th.-Breathing and hearing better. Dullness caused by the pleuritic exudation has diminished greatly, and was entirely gone by 22nd. (WEKERLING, Deutsch. Archiv f. kl. Medorrhinum, xix, 319.)
10. Dr. JAMES RUSSELL reports 55 cases of acute rheumatism treated with S. of soda or ammonia in doses of 10 gr. and upward. In 9 vomiting occurred after the larger doses; in 6 there was delirium, protracted in 2, fatal in 1. The following cases are detailed:
10 a. Boy, aet. 15, of weak mind, took 10 gr. every 4 hours for 6 days with great relief, though there was occasional vomiting. On 6th n. he screamed for some time, and died suddenly in m., temp. then being 99.6. Lungs were found much congested and highly oedematous; right auricle gorged.
10 b. A nervous man took 10 gr. every 2 hours for 2 days without relief; dose was then doubled and 2 days later, was raised to 25 gr. Pains being then relieved, dose was lowered to 12 gr. that evening, and 8 gr. next m. He was depressed and delirious during n., severely delirious during day, and died suddenly in following n. Temp., which had fallen to 100, rose to 111.5 just before death. R. side of heart was found full of dark tar-like blood, and there was considerable ecchymosis under serous membrane. (Brit. Medorrhinum Journ., 1882, i, 459.)
11. A stout, well-nourished woman, aet. 25, was treated for acute rheumatism with Salicine, in 10 10 to 30 gr. doses every hours or two. During the 5 days she was under treatment she must have taken about 1400 gr. Nevertheless (?) on 3rd day temp., which had been 103-104, began to rise, and after a fall on 4th day (when there was vertigo, with tinnitus), on 5th m. was again 104.8. S. was now given in 30 gr. doses every 2 hours, but as temp. continued to rise, and patient complained of burning sensation, it was stopped; this was at 4 p. m. Symptoms of delirium began to show themselves, though pains were apparently relieved. At 9 p. m. she was restless and wandering; face flushed, eyes bright; tongue and skin dry, with eruption of miliaria; pulse 145, temp. 105. Next m. at 2 patient was moribund, and at this time temp. was 111. The autopsy found all organs healthy, save that mucous membrane of stomach showed several patches of ecchymosis. (Lancet, March 3rd, 1877.)
12. A girl, aet. 17, had taken for acute rheumatism 15 gr. of S. ac. every 3 hours, 60 gr. in all. At 6 p. m. temp. was 100.4, pulse 120. At 9 p. m. pulse was same; but at 345 a. m. it had risen to 160, and she died quietly and suddenly. Heart was found enlarged and slightly fatty; there was pericarditis, but without effusion. -Reporter had seen in the course of treatment of this disease by S. acid 3 sudden unexpected deaths. All the patients were girls and in their first attack. (GOOD – HART, Medorrhinum Times and Gaz., 1880, i, 105.)
13. EMPIS gave S. acid to a patient at 5th-6th day of a very severe and painful attack of rheumatic fever. He took 7 grm. on Ist day, 5 grm. on 2nd, 3 grm. on 3rd. After the 5th dose the pains disappeared as if by magic; but on the third day the patient all at once felt a violent pain in the epigastric region, and suddenly expired. There was no autopsy. (Bull. de l’ Acad. de Medorrhinum, 1877.)
14. C. W -, aet. 55, was admitted at 2:30 p. m. Nov. 3rd, 1886. By mistake, she had for 17 hours been taking (for subacute rheumatism) 30 gr. of S. of soda every 4 hours, left evening 120 gr. in all. She complained of buzzing noise in ears, some headache, and great deafness (she was naturally slightly deaf); pupils were extremely contracted; urine contained a large quantity of S. acid and albumen, about 1/10 of latter depositing after boiling with a little nitric acid. A saline purge was administered. Next day all symptoms had considerably abated; urine still contained a large quantity of S. ac. and a trace of albumen. On 5th albumen had quite disappeared; and on 6th S. ac. was no longer discoverable, and pupils had resumed their normal size. (Brit. Medorrhinum Journ., 1877.)
15. In the Guy’s Hospital Reports for 1886 – 7 I adduced some reasons in support of the view that other haemorrhages besides epistaxis, which had been so frequently observed, was occasional accidents during the administration of large doses of Salicylate of soda in the treatment of acute rheumatism. The cases there recorded at length to illustrate this fact were one of retinal haemorrhage and two of haematuria. During the last year there have occurred at Guy’s Hospital two instances of a similar result of this treatment, in both of which the bleeding was from the gums. By the courtesy of the physicians who had charge of the case I am allowed to put them on record.
15 a. Annie P -, aet. 27 married, was admitted under the care of Dr. Goodhart on Sept. 13th, 1888, suffering from a first attack of acute rheumatism. There was a very good family history, and the patient had never been laid up with any illness except her confinements. Her present illness began one week before admission, and appeared, when the patient was first seen, to be a typical attack of acute rheumatism. Several joints were red and swollen; there was no cardiac complication and no albuminuria. The temp. was 101, and did not exceed this at any time during the disease. She was at once ordered 20 gr. of S. of soda in a mixture of liquor ammonia acetatis and water every 3 h. The pain and fever were so far subdued by this treatment that on the 17th the medicine was ordered to be given every 6 h. On the 21st it was altered to 3 times a d. At this time the patient suffered slightly from deafness, singing in the ears, and hallucinations of hearing. On the 24th profuse bleeding from the nose and gums began. The bleeding continued in varying quantity until the 28th, that from the gums being the more severe. Altogether she lost a large amount of blood, becoming pale and weak, with a small rapid pulse. Large clots collected in her mouth, and her motions were blackened, apparently from swallowed blood. When the hemorrhage began, the salicylate was stopped, a solution of tannic acid was ordered as a mouth wash, she was given ice to suck, and a mixture containing 25 minims of tincture of hamamelis and 10 minims of tincture of perchloride of iron was prescribed. On the next day, with the view that the hemorrhage might be a manifestation of a purpuric or scorbutic tendency, lemon – juice was ordered. As before mentioned, the hemorrhage, entirely ceased on the 28th, and from that time the patient did well until Oct. 5th, when a slight relapse of the articular inflammation occurred, there being pain in one wrist, with a temperature of 99. Ten gr. of S. of soda were ordered 3 times a d. The next day at noon the bleeding from the gums began again. It was not nearly so severe as on the previous occasion, and ceased on the evening of the same day, the salicylate having been stopped and similar measures taken to arrest it. The patient left the hospital on Oct. 9th, quite well. The patient stated that she did not remember that her nose or gums had bled on any previous occasion. In the intervals between the attacks of hemorrhage the gums were not spongy nor easily made to bleed. At no time were purpuric spots observed upon her legs.
15 b. William H -, aet. 26, a porter, was admitted into Guy’s Hospital, under the care of Dr. Pavy, on May 23rd, 1888. He had previously enjoyed good health except for slight headaches. The family history was good. The present illness began a fortnight before admission with pains in the limbs, and when the patient was first seen he presented the symptoms of a moderately severe attack of acute rheumatism, there being inflammation of the knees, shoulders, and hips, with a temperature of 102.4. There was no cardiac complication, and no albuminuria. The patient was at once ordered 20 gr. of S. of soda in peppermint water every 4 hours, and on the 25th the medicine was ordered to be given every 2 h. On the 26th it was noted that the patient was sweating profusely, that there were inflamed sudamina on his chest, and that he was very deaf; so that in the course of day, the medicine was prescribed every 4 hours, as at first. On June Ist Salicine in 20 gr. doses was substituted for the salicylate, the mixture being taken every 3 hours, and on the next day the following note was made: – “The patient is breathing noisily 25 times per m., his face is cyanosed, and there is abundant perspiration on his forehead and chest. His gums are spongy, and bleed on the slightest pressure. The tongue and palate are covered with large hard crusts of blood, which has evidently been oozing for some time. The pulse is soft and regular, 88 per m.” This hemorrhage from the gums continued till June 6th, when it was noted that the clots of blood had disappeared from the tongue, though the gums still bled on pressure. On this date the Salicine was ordered to be given every 6 h. From this time the patient made a slow recovery, having a slight relapse on the 14th, on account of which the Salicine, which had been for some days taken only 3 times daily, was again taken every 6 h. Two day after this change the patient had a slight return of the bleeding from the gums. This and the relapse of joint trouble lasted but a short time, and the patient was discharged cured on June 16th. For a few days during his stay in the hospital a soft systolic bruit was heard at the apex of the heart. (LAURISTON SHAW, Lancet, 1889, i, 114.)
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.