China. more or less flatulence or extreme tympanitic distention of the abdomen; stools painless; yellow, liquid, sometimes fetid, liable to come on after eating or drinking; tongue coated, white or yellow, bitter taste : extreme weakness; coldness of the prominent parts of the face, nose, ears, cheeks.
The diarrhoeic stools of Phosphorus and Croton have been described before.
Mercurius. Stools green, watery, slimy, with or without blood-streaks. (Let it be remembered that Terebintha has watery slimy stools). Bad smell from the mouth; region of liver painful to contact; presence or absence of tenesmus.
Mercurius Sulph. Stools of the same consistency as the cholera stools (rice-water stools) but yellow.
Gratiola. Yellow stools, persisting yellow vomiting, excessive thirst, which appears to complicate the gastric disorders.
Lastly I would remind you of Oleum Ricini which might find a place in some cases of diarrhoea, not coming under the above designations.
It is bad practice to alternate remedies in this stage. The remedy should be so selected that it suits both the fever and the diarrhoea.
Stools resembling bloody serum, point to Rhus Tox., Ricinus., Phosphorus; dysenteric stools, to Cantharis, Mercurius Corrosivus; haemorrhage from the bowels to Carbo Veget; discharge of black, liquid blood to Elaps., Arsen-Hydrogenis. This latter drug has bloody stools with scrapings, or stools like flesh water, with scrapings. Such stools occur often at the end of the rice-water stools, just about the time when reaction is to set in; there is congestion towards the pelvic region with burning in the urethra and tenesmus–all this points to Cantharis; the scrapings distinguish the Cantharides from the Mercurius Cor. stools.
I would particularly draw your attention to the following statement of Dr. Macnamara which has but too frequently been verified in practice. Another complication incident to the stage of reaction, which seems to me more common amongst the natives of this country than among Europeans, is the formation of a clot in the right side of the heart, usually extending into the pulmonary arteries. The patient seems to be doing well, when, suddenly, difficulty of breathing comes on, followed by collapse and death. I have seen more instances of this kind during the present season (1869) than I remember on any former occasion, and they render one extremely cautious in giving a prognosis, even in cases which, to all appearance, are doing remarkably well.
The nature of this most unpleasant incidence is so, that we can hardly provide against it. Dr. Buchner states that Calcarea Arsenicosa prevents the formation of coagula. I cannot say by what mode of reasoning, or by what sort of clinical experience he arrived at that conclusion. The formation of a clot in cases of cholera is not owing to formation of coagula, the fibrin being in all cholera cases conspicuous by their absence; it is owing to a fusing together of the red blood corpuscles, because they have lost their corpuscular structure and power of coagulation. I have, however, taken the hint, and found that Calcarea Arsenicosa 6th to 12th is certainly an excellent restorative in the asthenic sequelae of cholera.
In this season (1886-87) death in consequence of embolism is very frequent. Formerly we heard it exceedingly seldom that a cholera patient died suddenly but now half of them, I should say, die in this manner. The patient is apparently doing well, vomiting and purging have just ceased, or are about to cease; he gets somewhat warmer and is quiet; we should expect a gradual reaction, while all of a sudden the patient gasps his last, or he turns to his right or left side, and is thought to fall asleep.
While he is, to the surprise of those around him, found dead.
Are we, at such a season, to administer Calcarea Arsenicum when the urgent symptoms of vomiting and purging subside, as a sort of prophylactic? Are we to pin our faith to Calcarea Arsenicum to the exclusion of all other remedies, along the whole cholera treatment? These are two important questions, which can only be answered by a third one : What has clinical experience to say to all these suggestions?
Terebinthina is said to be a coagulator of blood, so are the Salts of Iron. Should we employ Ferrum Arsenicosum? Should we administer Terebintha in cases where it is considered advisable to do something to bring on the secretion of urine? Lastly we should not forget Ammonium Carb. which is said in Allen’s Hand Book of Materia Medica and Therapeutics to be useful in cases of a threatening clot-forming at the heart. Ammon Carb. is, however, known to be a solvent of fibrine, at least in its primary action. Are we then to apply it in large doses on allopathic principles?.
