I have been particularly requested to give ample indications for the treatment of hiccough, a disorder of a most troublesome nature, and by no means insignificant, liable to occur with more or less severity and persistency, at the time when reaction is about to set in, or has already set in. My impression is that when practitioners do not succeed, they have to ascribe the failure to themselves. As a rule the patient is altogether forgotten in such cases, and the hiccough alone is treated. Why run after such remedies as Ignatia, Nux Vom., Cicuta or Belladonna, which have no relation whatever to choleraic patients? But when the patient, it might be said, is in a state of reaction, he is no more a cholera patient. Well, is not the physiological action of out cholera remedies followed by a reaction? Do you think that a man who has been poisoned by Veratrum, and has been actually brought thereby to a state of collapse–do you think that such a subject recovers without any transitory reaction? Just look at our materia Medica, please, and you will see there all the phenomena of a reaction clearly depicted under each drug’s pathogenesis. Why then run off the line in search after new therapeutic agents? Veratrum, Cuprum, Secale, Carbo Vegetabilis, Arsenic, Cuprum and Strychn,. Ars; (also Arsenicum Iodium when there is much wind;) Tabacum and its alkaloid nicotine and Hydrocyanic Acid, also Agaricus and its alkaloid Muscarine, they have all hiccough amongst their pathogenesis, and succeed far better–I speak from experience– than such far fetched drugs, that may have beneficial effects in hiccough occurring in common disorders of indigestion or spasms, but that have for all that not the slightest relation to the case before us. Hiccough may either be centric in its origin, in which case the seat of irritation is either at the base of the brain or in the cerebral portion of the spinal cord; or, secondly, the seat of the irritation may be somewhere along the course of the phrenic nerve, or at its peripheral extremity; or, thirdly, the irritation may be reflex. Besides, this hiccough has often been observed in protracted cases of anaemia; the irritation, in such cases, is supposed to be central, brought about either by insufficient nutrition (Cuprum, Veratr.) or by the retention of impurities in the blood owing to a defective tissue metamorphosis; such instance is met in the last stage of Bright’s disease where the blood is surcharged with urea. This will explain the frequent occurrence of hiccough in cholera. Two drugs particularly known to give rise to hiccough are : Tabacum and Alcohol. Amongst those who first try to smoke tobacco hiccough is a troublesome symptom. The drunken man is so well known to be afflicted by hiccough, that he is never caricatured without his companion. We should certainly first of all try in cases of hiccough a few drops of Rectified Spirit often repeated. Sulph. Acid prominently produces hiccough and should be remembered. Oxalic Acid should certainly find a place as a hiccough remedy in cholera collapse.
Similar remarks are applicable to the treatment of the reactionary fever. There was a time when a cholera patient was looked upon as three quarters saved when he had once reached the stage of reaction. Not so, since a few years; even in these matters the type of the disease has changed of late, at least in Bengal. In fact, people have learnt to dread the stage of reaction almost more than the stage of collapse. What lessons are we to learn from this, concerning our therapeutic proceedings? It appears to me, that we must begin to look upon these fevers, as they occur after the cold stage of cholera, as a part and parcel of the cholera attack itself, and arrange our treatment accordingly. Of all the drugs, Belladonna is the most misused on such occasions. Let us use Veratrum instead or, better yet, Euphorbium which acts similar to Veratrum on the digestive organ and, at the same time, similar to belladonna in regard to cerebral congestion. The late lamented Dr. Hering, who had felt years ago, the ill use Belladonna is put to by practitioners of our school, says : Both (Belladonna and Veratrum Album) are often indicated in typhoid fevers, it is true, in widely different cases, but sometimes the choice is difficult, particularly as Belladonna is equally applicable in apparently opposite states. Both have apathy, stupor, unconsciousness or great sensibility to noise and also to light; dislike to talk, except in delirium; (the latter sometimes is furious); great fearfulness; eyes dim and glazy, face pale or by turns red and hot, distorted features, sudden startings in sleep, grinding of teeth; both have much thirst, frequent drinking, but only little at a time; the mouth dry, saliva lessened; diarrhoea; involuntary discharge of the faeces and the urine; both have nymphomania and other uterine affections in common. With both the head is often turning hot, while the limbs are cold; both have an aversion to being covered, both indicated particularly in children and women, etc. Veratrum has a great similarity with Lycopodium in typhoid complaints of children; Belladonna with Rhus or Calcarea. Where there is so much similarity, I should say the decision should in most cases fall on the side of Veratrum, in post-choleraic fevers; especially as the signs of cerebral inflammation, so characteristic of Belladonna, are entirely absent in this class of fevers. In fact this characteristic absence of inflammation by itself, should suffice to determine out choice in favour of Veratrum; but we cling to routine and prescribe Belladonna.
The febrile symptoms brought on during a Camphor reaction are very marked, and typhoid in appearance; and so are the cerebral symptoms occurring at the stage of cholera-reaction. Hahnemann actually has put on record the great benefit he derived from the administration of Camphor, in a prevailing type of intermittent fever. Yet who ever thinks of administering Camphor at the febrile cholera reaction? I have shown before, that Cuprum has no less typhoid fever amongst its pathogenesis;the cerebral irritation it causes, is well-known in our school, not to be attended by any traces of inflammation; but it seems that there prevails a common and most erroneous impression, that remedies suited for the cold stage of cholera could no more be suitable to the opposite stage of febrile reaction. So long as the reactionary fever was in itself a sort of salutary transition from disease to health, it did not matter much how the patient was treated at that stage. When the fever constitutes, however, as it has been of late the case, a pathological disorder of its own–in fact the final issue of cholera; then none but the properly selected homeopathic remedies can be of any help, and they can certainly not lie far away from the range of cholera similars. Again some wise acres of practitioners would fly to the administration of Cina, never mind what may be the matter with the patient, as soon as they discover that the patient bores at his nose. Let them remember that Veratrum has also that symptom.
Of non-choleraic fever remedies, Rhus Toxicodendron and Phosphoric Acid have always maintained a reputation as beneficial in the reactionary fever. Bryonia and Baptisia are very rarely of much use; there is, however, no saying what may or may not be indicated in a certain case or epidemic, for each such case or epidemic must be treated on its individual merits. The febrile condition calling for Rhus is usually associated with restlessness, while dullness and apathy characterise the Phosphoric Acid patient. The indications for Veratrum, Cuprum, Secale and Camphor have been given in the course of these lectures. Colchicum may be called for in typhoid conditions with great tympany, body hot, extremities cold, stools flaky.
Local complications require specific organic remedies. Phosphorus, Tartar Emet., Carbolic Acid, in congestion of the lungs. Cuprum, Nux Vomica, Arsenic (high dilution), Ipecac, in gastric irritation. Excessive acidity we try to combat by Nux Vom., Calcarea Carb., Calcarea Arsenicum, Robinia, Carbo Veg., Lycopod., iris Vers., or Eupatorium Perfol. And last, though by no means least, Strychninum Arsenicosum should be thought of in all cases of extreme gastric irritation and rejection of anything taken, during the reactionary stage. I have found it successful when all other remedies failed. This excessive acidity is the consequence of a reactionary process. The choleraic evacuations being alkaline we may consider cholera at an end with the advent of acidity, in the stools or in the vomit. Nevertheless it would be unwise to leave the patient without further medical assistance the moment such acidity makes itself felt, subjectively or objectively. Experience teaches that reaction in excess is just as dangerous to life as the original disease. If my plan, as suggested before, is to be carried out in practice and Kali Arsenicum is to be given during the whole cholera process, where we now are in the habit of giving Arsenic, then Arsenic (which means Arsenious Acid) might be given from the moment acidity makes itself felt, I say again, subjectively or objectively, as shown by test-paper (Comp. pp. 122-123). Cantharides, Terebinthina, Carbolic Acid and last, but by no means least, Camphor, in congestions of the urinary apparatus. Nausea after drinking water with or without sour vomiting reminds one of Natr. Carb which should be superior to Nux Vom. usually given in such cases. Fetid stools often call for Psorinum, and so on. Retention of urine with a full bladder causes often great restlessness. The catheter may be applied in such cases; Camphor externally and internally, Cantharides and, last but not least, Petrosel. Cerebral congestion may require Hyoscyam., Cuprum. Camphor, and Cantharides. Cerebral paralysis, not associated with come : Lycop., Zincum met., Zincum Phosph and Baryta Mur. When associated with comma : Arsenic, Opium and Chloral. With hydrocephaloid symptoms : Helleb., Calcarea phos. and China. For all particular indication for the right and proper use of these medicines I must refer you to our standard works on Materia Medica and Pharmaco-dynamics. For the diarrhoea occurring at the febrile stage I have found either China, Phosphorus, Croton Tiglium, Podophyl., Mercury or Mercurius Sulph. most frequently indicated.
