This is, gentlemen, the last lecture I am going to deliver on cholera and its homoeopathic treatment. It is the last, not because the subject has been exhausted, and there is nothing left any more to say, but because I have exhausted all the knowledge on the subject, that is in me. We approach now the considerations referring to the treatment of the stage of cholera collapse, a most serious, complicated stage. Serious, in as much as only ten per cent. of patients spontaneously recover, if we are to believe Dr. Machamarra’s statement on the subject;complicated, because we deal here with a pathological state, the symptoms of which may be either spasmodic, or paralytic in their nature, or a combination of both. All this is so much the more true, the farther the stage of collapse is advanced.
Properly speaking, it is difficult to say, where the stage of collapse begins. It is a stage which is easier recognised as such, than defined by so many words. A low temperature 3 to 4 or 5 and even 6 degree F., below the normal standard, coldness all over, distinct signs of an impeded circulation and respiration, with or without purging or vomiting, constitute the chief characteristics of that stage. As a rule the evacuations are not considerable, the patient being exhausted, or emptied; nausea, retching, and now and then a small discharge of a rice water fluid from the rectum continue, however, often to the last.
That our best remedies will here often fail, is easy to see; we deal here no more with a morbid process; we deal, with an organism injured by a preceding morbid process–and nobody can tell, in how far the injury inflicted is within, or beyond possible repair.
I shall first speak of the condition of the blood. Physically it has become so far altered, as to have greatly lost its fluidity; it has become thickened, tarry, unfit for easy circulation through the minute capillaries of the organism. Physiologically it has experienced another great injury; it has been to a large extend deprived of its vivifying element, of its oxygen. With the serous dejection a considerable quantity of saline matter passes out of the body–another morbid alternation in the chemical constituents of the blood as a whole: although according to Dr. Garrod(* London Journal of Medicine, May, 1849.*) it would appear, that the proportion of water discharged is so much the greater, that the percentage of salts in the blood is rather increased than decreased.
However urgent the indications may be too minister to the functions of the organs of respiration and circulation, we must never, for a moment, loose sight of the grave condition of the blood itself, upon which after all the sustenance of the organs themselves depends. The calming of the irritation of the digestive organs will, therefore, engage our first attention. So long as the patient is not able to take, or to retain when taken, any liquid, so long must be considered not to be out of danger, however distinctly some signs of reaction may have made their appearance. We have seen in a previous lecture, what great advantage we may derive in such a state, from Ricinus and Cuprum. should ever Arsenic be called for in a similar condition, you will find that dilutions between the 12. and the 30. far superior to the lower dilutions. Constant nausea indicates Ipecacuanha, Tart.Emet.., Tabac. or Nicotine at any rate in the case of individuals not given to smoking tobacco. The nausea of Tabac. or Nicotine is accompanied by burning heat about abdomen, the rest of the body being cold and clammy. The patient persists in uncovering the abdomen. There is total indifference to nakedness. Carbolic Acid has done me good service in cases occurring in filthy quarter, infected by bad drainage: I gave the
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I must confess I do not like to see Carbolic Acid used as it is done in many houses, as a disinfectant of the choleraic stools. The Carbolic Acid smell is sickening to me, and I believe the patient is similarly affected, although he my not be aware of it.
In all cases where the state of the digestive organs engage our attention on the one side, and the state of some other important organ on the other, I propose that, in order not to neglect either the one or the other, to alternate or remedies, provided we cannot lay hold upon the drug which satisfies all the exigencies of the state present. Or, what I would consider still preferable is this: Let the water the patient is to drink be medicated by such of our medicines, which we consider best calculated, to enable him to retain his drink, and to combat at the same time the nausea and inclination to vomit, if there be any. Again vomiting, the gastric irritations in general might disappear first. The patient might even manifest some desire for some food, while the choleraic discharges are till going on. In such case, we should not hesitate to allow the patient some barley or arrowroot, salted, cautiously to take; while we might administer Veratrum, Crot. Tig. or Ricinus in order to control the stools. In most cases we shall find that the stools are not strictly choleraic under the conditions above mentioned. Sometimes they are watery and colourless, yet no more rice- watery; they appear to be watery mixed up with flakes of mucus. Here we might sometimes substitute with advantage Ol. Ricini 3 to 6 instead or Ricinus,
For the restoration of the function of the blood, as far as its oxygen carrying capacity is concerned, we have or at least we believe to have, one drug is our Materia Medica, of which clinical experience has spoken in very laudable terms. I speak here of Carbo Vegetabilis. It is supposed to act, both upon the blood and the various tissues of system, especially upon those portions of nervous system, presiding over nutrition; it devitalizes the blood and exhausts the nerves, at least this is the explanation given of the various phenomena of depression which its provers have shown to be produced, under its influence, on the organism. These symptoms of depression, let it be understood, have been obtained from experiments made with carbo-triturations. Charcoal in its crude state i n inert substance, void of any pharmacodynamic action. Triturated, it has however been shown by Hahnemann and his disciples to have pharmacodynamic powers in the direction mentioned. This is a matter of fact, and all what a priori-argument can ever say against it, will not affect us, who know, from other instances, that Carbo Veg. does not stand alone in this respect. Vegetable charcoal, in triturated form, has been used in our school against complaints connected with old age, with low fevers, and all such disorders, where the oxydation of the blood is known to be faulty. I cannot tell you who first hinted, that it should be tried in the stage of cholera collapse; but it was a very happy hit indeed. Both Baehr and Kafka speak highly in its favour, and I may as well contribute my own small share to the statements of others. Carbo Vegetabilis, says Dr. Baehr, has done us not infrequently good service at a period of the cholera process, where most of us are at a loss how too lay hold upon an effective remedial agent. It is indicted at the asphyctic stage, when vomiting and purging have ceased, when there are no cramps any more, the patient lying moreover extremely prostrated– corpse-like. Carbo follows often well after Arsenic; more frequently, however, it suits in case void of reactionary signs from the very beginning.
It is worth while noticing, that the effects of carburetted hydrogen closely resemble the asphyctic stage of cholera. In Allen’s Encyclopaedia, article Carboneum Hydrogenisatum, we read actually that it has produced in one man exposed to the gas rice- water stools, for sometime after the attack.
Carbo Vegetabilis produces haemorrhage from the bowels–a condition not very rare in far advanced cholera patients, the intestinal mucous membrane of such patients being in congested state. We have seen the benefit we may derive in such a contingency from Mercurius Corrosivus, or Ricinus when the discharge is more or less like bloody serum; Phosphorous should here be remembered and in connexion with typhoid symptoms-Rhus Tox; a discharge of a brown fluid would indicate Phosphorus.
Similar good results may be expected from Carbo Vegetabilis when the discharge consists of pure blood, oozing out of the rectum. Fetid discharges from rectum would also point to Carbo. Veget. Bloody serous evacuations during the reactionary fever point to Rhus Tox. It may be that it is in cases where there is internal haemorrhage that we derive most benefit from the administration of the drug in the stage of collapse.
I see Dr. Raue recommends Argentum Nitricum amongst other remedies in the stage of collapse, when dyspnoea is excessive owing to spasms of the respiratory muscles–a sort of dyspnoea the drug never produces, and a dyspnoea which is not frequent in the last stage of cholera; should it occur, then we have in Hydrocyanic Acid a far more reliable, and by far more promptly acting remedy, than in the nitrate of silver. This drug has been shown by the late Dr.V.Grauvogl to deprive the blood of its oxygen-carrying capacities; and Dr. Boglowsky’s subsequent experiments on animals fully confirm Dr. Grauvogl’s assertions. The salt has a direct and primary action on the red blood- corpuscles, causing their colouring matter to escape into the plasma. This is just what is taking place in cholera; and it is owing to this process that the blood of cholera subjects is found to be black, tarry. I should strongly recommend Argentum Nitricum in a low dilution, say the 3 decimal, wherever the dyspnoea is by far greater, than the state of the heart and the lungs could justify us too expect; in other words whenever we have ground to believe that the respiratory function of the blood is more damaged, than that of the respiratory organs themselves. This may, however, remind us of Hydrocyanic Acid or its salts (Kali Cyanatum or Sulphocyanide of Potass), or again of the snake poisons.
