But it is not only with regard to the stage of cholera- development that Cuprum has many points of similarity with the disease under consideration. As the disease advances towards the stage of collapse, dyspnoea assumes a prominent feature of danger owing, as you have learnt from Niemeyer’s description, cited in a previous lecture, partly, to the altered state of the blood and, partly. to the paretic state of the heart. But while all this is going on, there is a third element no less active in bringing about a final dissolution viz. the spasmodic contraction of the pulmonary arteries, which in itself constitutes a threatening danger to life. This danger is purely of neurotic origin; and Cuprum which counts difficult respiration of a similarly neurotic origin amongst its pathogenetic symptoms, may here be of great help.
Do you remember, what I told you in a previous lecture about the muscular unrest tormenting often patients in the state of collapse? Well, Cuprum is their grand remedy, if they be within the reach of remedies at all. In the Arsenic patient the restlessness proceeds from extreme anxiety; patient throws himself from one side to the other, because he wants apparently to better his position. The Cuprum patient moves because he cannot rest-because his motor centres are excited-and there is a certain cerebral excitement observable besides, while the Arsenic patient is mentally calm. Again, in the Cuprum patient the respiratory spasms are more fitful, while the Arsenic patient seems to be under the influence of an unremitting grasp of oppression. Gastric irritation is by no means so severe in Cuprum poisoning as in Arsenic; and this is one reason more, why Cuprum may be better indicated in some cases of collapse, than its rival Arsenic, the irritation being by far less in that stage than at the onset of the disease. I quote here form Dr. Hughes’Pharmacodynamics’: In 1886 Mr. Proctor, who treated a number of full developed cases with great success (he loss only 14 out of 08), writes :- For the cramps it was unquestionably the best remedy, and I may say for the vomiting also. In the stage of collapse, I generally found myself trusting mainly to Cuprum, and the impression is very strong on my mind that in collapse it is the most reliable of our remedies.’ It appears to go deeper into the organism and to fasten upon the disease with a firmer and more tenacious grip. Certainly it accomplishes much by keeping the stomach quiet, and thus enabling us to introduce and to retain, what other medicine, or stimulant or nourishment we may desire. This is certainly not the general experience of the profession, neither in India nor in Europe. Whenever the dyspnoea has, so to say, fastened upon the patient, we must recur to Arsenic, Camphor, Hydrocyanic Acid. or to such other remedies to be indicated hereafter. But we need not discard Cuprum, when otherwise indicated, at the first signs of a setting in of dyspnoea, especially so long as the difficulty of breathing is paroxysmal in this nature-going and coming-or getting better each time after vomiting has taken place.
Again the stage of collapse there may sometimes occur a state of intestinal irritation, arising out of a paralytic state of the intestinal coat. Choleraic secretions in such a state of things, would go on within the alimentary canal, but the power of expelling them is absent, the preceding colicky spasms of the intestines having culminated in a state of muscular exhaustion; this may, however, not always be the case, for the retention may be owing to a spasmodic state of the intestinal muscular coat; the secretions lie then within the intestinal canal as a foreign body, causing local irritation with consequent restlessness. If this state is allowed to go on for a time unchecked, then the choleraic secretions within the intestines undergo partial decomposition, various gases are generated, which distend the intestinal canal, press upon the intestinal walls and increase thereby the very paralytic state of its muscular coat. Gradually the whole abdomen becomes enlarge, and to all the troubles extant there is super-added a state of tympanites, a state most uncomfortable in persons otherwise healthy, but dangerous in the case of a cholera patient. The tympanitic distension of the abdomen has the consequence of pressing upon the diaphragm, thus interfering with the act of breathing, which is, in the stage of collapse, but too deficient, as it is. Homoeopaths are in the habit of prescribing in such cases Carbo Vegetabilis, Lycopodium, Terebinthina, Asafoetida, Nux Vomica, etc. With the exception of the first named none of these remedies are homoeopathic to the case; and not always do we succeed with Carbo Vegetabilis, which is only indicated when the state of collapse is rather far advanced. We need not wonder, that out practitioners have not fared better in such contingencies than the allopaths. There are only few drugs in our Materia Medica, known to paralyse in their primary action the intestinal, muscular coat; Plumbum, Alumina (?) and Opium stand foremost amongst them. The two first named remedies are slow in their action and have besides no further similarity with the case before us. Opium, however, acts promptly where indicated, and has, moreover, produced in many a prover watery diarrhoea! Opium is, therefore, the truly homoeopathic remedy in the case described before, and I may say, many a life has been saved by me, through the timely administration of that drug, so helpful whenever indicated. I usually prescribe one drop of the 3rd decimal in an ounce of water, a teaspoonful of which mixture to be taken every 15 to 20 minutes.
Unfortunately the very state in which Opium would be so eminently indicated, had it been brought about by the natural courses of the disease-this very state is but too often the consequence of a previous administration of Opium on the part of some mischievous allopath, who had been called in at the onset of the disease. Under such desperate circumstances we may still derive sometimes some benefit from the administration of Veratrum Alb. mother or 1st decimal. This often brings on the choleraic secretion, and the tympanites is often relieved in a very short time. Should on the other hand there be reason to believe that the tympanites is owing to a spasmodic state of the intestinal muscular coat then I use the 3rd decimal of the Acetate of Copper (for it is this preparation of copper which almost invariably produces distention of the abdomen, with sensitiveness to touch) in the same same way as I indicated before with regard to Opium. Should this be of no avail, I still cling to Cuprum Acet. as almost the only sheet anchor, and try the drug in a higher dilution. I have seen enough of Lycopod., etc., in such cases, and am satisfied that there is no satisfaction to get out of them. The tympanites they are capable of producing and eventually curing belongs to quite another chapter altogether. As a differentiation between the paralytic and spasmodic state it may be mentioned that the first has no sensitiveness to touch while the second has; the first is liable to occur along with other spasmodic phenomena, the other during the state of pronounced collapse. Nicotine is another drug of great usefulness in such cases. This drug corresponds, however, to a variety of cholera quite different from that to which Cuprum corresponds. I shall come back to Nicotine in the course of these lectures. Again, we have in Colchicum another remedy closely allied in its pathogenesis to cholera and known to produce almost invariably tympanites. Colchicum, however, belongs also to another class of cholera; it belongs to the Veratrum variety, of which more later on. In the spasmodic variety of cholera, Cuprum stands first whenever tympanites intervenes (*It should, however be recommended that the Veratrum variety is by no means strictly diarrhoeic in its nature. Veratrum is primarily a paralyser and secondarily a spasm-producer.*).
Hiccough is is another most troublesome attendant of cholera; it is a nervous disorder affecting the diaphragm and the glottis at the same time, the one being, at regular short intervals, convulsively contracted, while the other closes suddenly. There are a good many drugs known to affect the respiratory muscles, including the diaphragm through the phrenic nerves; but there are very few which affect the glottis in a purely spasmodic, non-inflammatory, manner. Cuprum takes the lead amongst them, and so does it also in cases of hiccough; although Arsenic, Veratrum Album, Lycopodium, Cicuta Virosa, Physostigma or Secale Cornutum may sometime be required.
The mention of such drugs as Cicuta Virosa, etc. in connexion with cholera, reminds me to say a few words about the apparent neglect of all such anti-spasmodics on homoeopathic ground, in cholera. No one has ever yet derived any benefit from Cicuta or from Nux Vomica or Strychnine in the first stage of the spasmodic variety of cholera. Dr. Russell tried Oxalic Acid-a drug, according to my estimation of its physiological action, standing between Strychnia and Arsenic-without any result whatever, and soon gave it up for good. The fact is, all these drugs are spinal irritants, with some of them the irritation set up going on to inflammation, while the cholera spasms are purely nervous in their nature. In conformity with this difference we find in the one case the spasms attended by high temperature, owing partly to inflammation and partly to muscular contraction, which is in itself a source of heat; while cholera spasms are attended by a temperature below the normal standard. Furthermore, the cholera spasms are not spinal at all in their origin; they are partly asphyctic in their nature, starting as such from the medulla oblongata, and partly cerebral, starting from the various motor centres and particularly affecting the extremities. Again the difficulty of breathing in the case of Strychnine poisoning is owing to tetanic spasms of the respiratory muscles, which are under the control of the phrenic nerves, the same taking their origin in the cord; while in spasmodic cholera the difficulty of breathing is due to morbid irritation of the vaso-motor centres and the consequent contraction of the pulmonary arteries and the arterial system in general. These are the reasons why the above mentioned drugs are not indicated in the homoeopathic treatment of cholera; and why, on the other hand, such drugs as Camphor, hydrocyanic Acid, Arsenic and Cuprum have found a suitable place, as therapeutic agents, either in the spasmodic variety of cholera, or in choleraic spasms.
