Poisoning
1. a. G. S. -, seen to stagger in the streets (of Milan), was taken in a carriage to Moro’s pharmacy. He was visited there by Drs. Casanova and Cavalleri, and by the surgeon Gonzales. Seated and perspiring, he called out in a strong natural voice that he was seized with the cholera, then prevalent in the city. He complained of formication in legs and arms, and of a feeling of spasm in his throat and stomach, with vain attempts to vomit. No choleric physiognomy Dr. Casanova tried to calm his fears, and prescribed 3ij of peppermint water with 3j of anodyne liquor and one of laudanum, which the patient took by degrees. Flatus came away, and the spasm of the stomach appeared to subside. Then he of his own accord and lay down on the bed, but his cries and fear of cholera did not cease, notwithstanding the assurances of all the doctors who came to see him. The above symptoms, whilst increasing, were accompanied by spasmodic contractions and opisthotonos; the formication in the extremities changed into cramp; the spasm of the stomach reappeared alternately with that of the throat, and was complicated by painful jerks as if from electric shocks every time the extremities or any part of the body was touched. Dr. Casanova thought there was an acute affection of the spine, and bled him, with the approval of the other physicians. The blood gushed out as if from an artery, and coagulated in the usual manner, without any special appearance of the serum, either in quantity or quality. Towards 4 o’clock, G. S – seemed quieter, the spasmodic contractions appeared at longer intervals, but the general jerkings increased in violence; the slightest touch provoked them. The patient still insisted on his fears of cholera, and desired to be taken to the hospital. As much to humour him as to rid the Moro family of such an inconvenient guest, his request was granted, and he was taken there about 7 o’clock; but on the way from the surgery to the hospital the patient died.
1b. the post – mortem examination required by law was made by Drs. Antonio Tarchini – Bonfanti and G. Martinelli about 24 hours after death.
Exterior appearance: G. S -, apparently about 45 years of age, was tall, well made, and finely proportioned, robust, and of embonpoint. The face of the corpse is calm, the pupil moderately dilated, the mouth closed but not contracted. The neck is a little large; the chest ample, dilated, and very sonorous, the abdomen slightly swollen; the upper extremities are very flexible, the lower extremities rather rigid, the fingers clenched, but not quite closed. The corpse lies on its back; the front of the body is pale, but the posterior is entirely of a violet colour, as if cyanic; this colour is also seen in the fingers, and is strongly marked in the scrotum. The cadaveric odour is slight. No trace of lesion exists on the exterior.
Head: Infiltrated blood in posterior portion of scalp; skull of normal thickness. The dura mater, of a white pearly colour, adheres strongly to the level of the sinus, which contains a little darkish blood, rather fluid than thick. The arachnoid and pia mater are thin and transparent, showing a very few bluish vascular ramifications. The grey substance of brain is pale and a little dense, the medullary portion is milk – white and firm. The plexus charades is of a rose colour. The pineal gland is ash – coloured and soft. The venous sinuses at the base of the brain retain a small quantity of thick blood. The cerebellum is in the same condition as the brain.
Spine: On opening the vertebral canal there is an abundant sanguineous effusion, and here and there circumscribed collections of black blood. The dura mater lining the canal is red, dull, giving the appearance as if the whole cord were made of red wax; the arachnoid is transparent; the pia mater strongly injected; the substance of the cord normal.
Neck: Some of the cervical glands are of the size of a filbert; the thyroid gland is a little larger than normal, reddish, but healthy in its texture.
Chest: The mucous membrane of larynx, trachea, and bronchi is rose coloured, covered with a little mucus; the bronchial ganglia are blackish and a little swollen. The lungs are pressed back from the sternum to the extent of three fingers’ breath; they are ashy, with large black spots, light, feebly crepitant, and congested with blood. No serous effusion either in pleura or pericardium.
Heart is flaccid and so softened that it is most easily torn; it is filled with red blood. Its volume is one fourth larger than the fist of the corpse. On the anterior and external surface there is a strong and resistant cartilaginous patch. Its various cavities contain a small quantity of dark, thick, viscid, coagulated blood; valves normal. The arteries and veins contain a certain amount of blackish pitchy blood.
Abdomen: No serous effusion. The liver of moderate size, dull red, dense, granulous, presents an engorgement of blackish, thick blood in the principal branch of the portal vein. Gall – bladder is full of viscid, greenish bile. The spleen is small, pale red; the pancreas is pale and hard, enveloped in a thick coating of fat; the kidneys are of a dull red colour, and the tissue very dense.
The mucous membrane of mouth, of pharynx, of oesophagus, is rose – coloured and normal, that of the stomach is pale rose colour without any partial injection, and covered with whitish mucus; the cardiac and pyloric orifices normal. The intestines are rather pale and distend with gas, otherwise normal. Strychnia was found in contents of stomach. (TARDIEU, Empoisonnement.)
2. a. A lad of 17 swallowed, immediately after dinner, about 40 gr. of pure S., and washed it down with a glass of wine and water. Immediately afterwards he began to feel uncomfortable, ran about the room, and experienced much anxiety and restlessness. 4 gr. of tart. em. were given without causing much vomiting, and the reporter saw him 1/4 hours after the poison had been swallowed. He lay stiff and unable to move on his back in bed, the head drawn forcibly backwards; he showed an inclination to turn on the right side; he could still freely use his arms. His countenance was pale and altered; temperature of the skin normal; pulse quick and wiry. His consciousness was perfect, he spoke in his natural voice about his state; he was occasionally interrupted by a transient stiffness of the lower jaw, but not to such an extent to prevent him speaking quickly and easily. This stiffness did not prevent him opening his mouth to take liquids, which he swallowed easily. The trismus gradually increased, and the spasms soon involved the muscles of respiration. The chest was oppressed, the breathing irregular and interrupted, and occasionally there was a rapid succession of short respiration, with small, contracted, and rapid pulse. Every effort to excite vomiting was unsuccessful. While still retaining consciousness, there occurred a succession of attacks of trismus and oppression of the chest, with a few m. interval between each, which continued to increase in violence, soon extending all over the body; and all of a sudden the patient experienced a series of almost electrical shocks throughout the body, and after a short pause opisthotonos followed, whereby the body, though not much bent backwards, was, throughout its whole extent, as stiff as a statue, and was raised a few inches from the bed in the middle. This state was accompanied by the most violent suffocative symptoms. During this attack, wherein the trismus was extreme, but without any distortion of the muscles of the face, he uttered bleating noises, and seemed to be trying to speak. The upper extremities were firmly drawn over the chest, the forearm immovably flexed at the elbow; the lower extremities were stiff and immovable, the feet were bent in such a manner that the soles were opposed to one another. The skin assumed a bluish colour, the face was puffed, of a dark violet hue, the lips dark blue, the neck swollen, the jugulars distended, the eyes projecting and turned immovably towards the right side, the pupils dilated and unaffected by light, the conjunctiva red. He now ceased to utter any sound; he became unconscious as if suffocated, and the body lay still and stiff. All at once the spasm ceased; the arms fell by the side of the body, the mouth opened, and he drew a deep breath, whereby he seemed to revive and resume his senses, speech, and power of swallowing. The dark coloration of the skin likewise went off. The contraction, however, continued in the muscles of the back, neck, and legs, but he could move his arms freely. Even after the third attack of this sort, the patient recognised the bystanders, and seemed to understand questions put to him, though he was unable to answer them intelligibly. In the fourth paroxysm he died, 1 1/2 hours after the poison had been swallowed.
2b. Post – mortem, 20 hours after death. Surface of body blue; abdomen tense, hard, but not swollen. The whole corpse uncommonly stiff; all the muscles rigid, especially those of the lower extremities; the feet still distorted. The flesh of the muscles, notwithstanding their stiffness, was uncommonly soft and doughy, and of a brownish colour like smoked meat. On opening the special canal there flowed out about 2 lbs. of viscid, not coagulated, black, tar – like blood. The plexus venosi spinalis, which are in ordinary states unnoticeable, were distended with dark blood; and between the fourth cervical and fourth dorsal, and again between the tenth dorsal and fourth lumbar vertebrae, they had the appearance of a thick black venous net, some of the veins being as thick as a crowquill. The vessels of the pia mater of the cord showed the same congested appearance, especially at the corresponding points. Within the membranes some exudation was observed, more particularly about the cervical portion. The cord, when cut across, was at its upper parts soft, in some parts even pappy; lower down it was harder. The cranial cavity was also congested; all the vessels of the dura and pia mater, especially the choroid plexus, and even the cerebral substance, were full of blood, whereby the cortical substance appeared of a bluish colour. The cerebellum was rather softer than usual. The organs of the chest and abdomen were, on the contrary, very destitute of blood; the heart was flaccid, and its cavities and large vessels so empty that scarcely any blood could be obtained from them. The stomach was distended with solid food, which had quite a fresh appearance. The mucous membrane of the stomach was much reddened, that of the small intestines slightly so. Liver full and distended, more full of blood than the other viscera, otherwise nothing abnormal. (BLUMHARDT, Frank’s Mag., ii, 234.)
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.