19 a. A young man who spent part of his time in society, where he smoked more than 20 cigars daily, from a certain time felt his digestive functions becoming impaired, his strength failing, his memory growing weak; and he became absolutely impotent. Wishing to marry, he consulted a physician. By his advice he broke with his associates and renounced his tobacco. His health returned, and with it his virile capacities.
19 b. M. Martin-damourette was consulted by a young physician the subject of complete sexual frigidity, for which he had taken without effect of any kind, doses of strychnine increasing at length to 36 centigr. daily. No cause for the impotence appearing, he was questioned about smoking, and confessed to having a cigarette in his mouth the greater part of the day. His muscular energy and resistance were sensibly diminished. The abandonment of tobacco completely cured the impotence, – no other therapeutic measures being needed.
19 c. A robust young man became inspector of the tobacco manufactures. After some time, he experienced a great enfeeblement of his genital power, and at last became impotent. After a fruitless trial of tonic and stimulant measures, he decided on leaving his employment, and his sexual power was not slow in returning. (FOUSSARD, Etude sur le tabac, Paris.)
20. a. The symptoms of central toxic amblyopia, which is a rather common affection, are: gradual failure of sight to much the same extent in both eyes; absence of any restriction of the field of vision, or indeed of any interference with the functions of the peripheral portions of the retina; and the existence of an oval scotoma, most marked for colours, extending from the point of fixation, which it involved, to the blind spot. Most of such cases are met with in men after age of 40. Occasionally younger men are affected; the youngest undoubted case I have seen was 20. This form of amblyopia is very rare in women, though not quite so rare as was at one time supposed. Those who suffer from it are almost invariably smokers; and generally they have smoked for many years before becoming affected. It is very doubtful if alcohol has anything to do with it, though this is maintained by some. Certainly one not infrequently finds that those affected not only smoke, but also drink to excess; yet the same symptoms are never observed to follow the excessive use of alcohol alone, though they are very frequently met with in smokers who abstain from alcohol in any form. As a rule, when the affection begins, no change has been recently made in the amount smoked, and this circumstance accounts for its being comparatively rare to find the patients suspect the cause of their amblyopia. Indeed, they not infrequently begin to smoke more after their sight has begun to fail, on account of the worry that this causes. Very often smoking is indulged in on an empty stomach, the first thing in the morning or late at night or in case of bad sleepers, during the n. It is owing to this circumstance, probably more than to the difference in the kind of tobacco smoked, that tobacco amblyopia is more common in the working than in the educated classes. Many men have to rise early and work several hours before partaking of a substantial meal, but nevertheless smoke during this time…. As a general rule not less than 3 – 4 oz. of strong tobacco are smoked in the week, often much more, – in exceptional cases less. In women a smaller quantity seems to suffice to bring on the symptoms The symptoms are produced by chewing tobacco.
20 b. The defective area is oval in shape, with its long diameter horizontal, and stretches from the outer side of the blind spot to very slightly to the inner side of the point of fixation. It corresponds to the external projection of that portion of the retina which lies between the optic nerve and the outer margin of the macular, a portion which recent investigation has shows to be supplied by a special bundle of optic nerve- fibres-the so-called papillo-macular bundle. the form sense as well as the colour sense is defective over this area…; the defect is most marked for red and green… As it is only over a particular area that the colour sense is defective the patients are often not aware of the colour-blindness they have acquired; a large surface of red or green appears to them quite as distinct as formerly…. Individuals with tobacco amblyopia often complain of seeing worse in a strong light…. The lesion which produces this peculiar form of amblyopia is not known. the regularity in the shape of the scotoma, as well as the complete recovery which so often takes place, renders it extremely unlikely that, as has been maintained by some lately, it is a form of retrobulbar neuritis…. It is much more probable that the poisonous effect is exerted on some part of the brain which includes the central terminations of the papillo-macular fibres.
20 c. A large proportion of cases completely regain vision if the tobacco be stopped. Improvement, though less rapid, generally takes place when the amount consumed is reduced, or when the quality of the tobacco used is milder. (BERRY, Diseases of the eye, 1889.)
21. I wish to make some remarks on a form of bad vision caused by the use of tobacco, and will call special attention to seven cases occurring in women which I have observed at the Manchester Royal eye Hospital. All complained of a rather rapid deterioration of vision, and the funds were either quite normal or only showed very insignificant changes. How then was the diagnosis made certain in these, as it is in all cases of tobacco amblyopia, by the presence of a central colour scotoma? this rest is easily applied by causing the patient to cover scotoma? this test is easily applied by causing the patient to cover one eye, while with the other he or she gazes steadily at the eye of the examiner, who then brings a small piece of red or green paper, fixed on the end of a pen, into the centre of the patient’s field, and notes the presence or absence of the patient’s field, and notes the presence or absence of the patient’s perception for colour in that part of his field. This test, so easily applied, is, I believe, an infallible test of bad sight produced by tobacco; and, further, I have never met with a central colour scotoma in a person who did not use tobacco, though I ought here to say that some such cases have been recorded. In my experience, then, a case of central colour scotoma is synonymous with tobacco amblyopia. I cannot too strongly insist upon the necessity of allying this test in all recent cases of failure of sight, whether in man or women, where the ophthalmoscope reveals a normal, or nearly normal, state of the funds, and you will be astonished how large a proportion of such cases will fall under the head of tobacco amblyopia. Hardly a day passes at the Royal eye Hospital without a case turning up. We must not be thrown off our guard by any slight changes we may find in the funds, and at once conclude that they are the cause of the defective sight, for they may be only accidental changes in a case of tobacco amblyopia, and have little or nothing to do with the bad sight. For example, in three cases I have seen a solitary retinal haemorrhage confined to one eye, the vision being equally diminished in both; in several, fine vitreous opacities; in other high degrees of myopia with posterior staphyloma, and in one woman I at first imagined the bad sight to be due to the presence of a few very minute white ticks at the maculae, which were only made out with difficulty by the erect image. In this case I afterwards found a colour scotoma, and elicited the fact that the patient smoked. Again, I have seen two cases in patients with well-advanced locomotor ataxy, and have no hesitation in saying that it was tobacco, and tobacco alone that was the cause of the bad sight. professor Hirschberg, in a paper on tobacco and Alcohol amblyopia, in the second valuer meet with the disease in women; ” and the only cases I have sen recorded rises my own were published by Mr. G. A. Berry in the ‘Ophthalmic Review,” April, 1884. I may further add that at the royal Eye Hospital the first diagnosis hat at the royal eye Hospital the first diagnosis of the n was made rather less than twelve months ago. (GRIFFITH, Brit. Med Journ., Dec,. 18th, 1886.)
22. M. Guelliot gives the following as the characters of tobacco amblyopia: It always commences in one eye (generally r.). At first patient sees through a mist, with central scotoma; then from time to time he sees objects yellow. There is no confusion of colours. Sight in worse in e. Pupils are contracted and immobile. (Alcoholic amaurosis, on the other hand commences in both eyes at once; there is confusion of colours, sometimes pain; and patient sees better in e.) (Le Progress Medical, June 2, 1877.)
23. Dr. CHAPMAN states that he was consulted by a member of congress, in the meridian life, and of a stout frame. “He told me that from having been one of the most healthy and fearless of men, he had become sick all over, and as timid as a girl.” He could not even present a petition to Congress, much less say a word concerning it, though he had long been a practicing lawyer and had served much on legislative bodies. By any ordinary noise he was startled or thrown into tremor, and was afraid to be alone at n. His appetite and digestion were gone; he has painful sensations at the pit of his stomach, and unrelenting constipated bowels. During the narrative of his sufferings his aspect approached the haggard wildness of mental distemperature. On enquiry, I found that his consumption of tobacco was almost incredible by chewing, snuffing and smoking. Being satisfied that all his misery arose from this pernicious weed, its use was discontinued, and in a few weeks he entirely recovered.” (Lond. Medorrhinum Gaz., xxxvi, 981.)
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.