I hear you ask: But what has all this to do with the first stage of spasmodic cholera? Dr. Russell made use of the drug at the stage of collapse, and so has surgeon-Major Hall. My answer is: The benefit to be derived from the drug in the far advanced stages of cholera, should not deter us from using it, wherever indicated, in any of the previous stages of the disease; and I do not hesitate to say, that in what Hahnemann called the first stage of the spasmodic variety of cholera, Hydrocyanic Acid is just as eminently homoeopathic as Camphor. Then there are cases where the spasmodic contraction of the heart causes pain in the praecordial region at the very onset of cholera, or in the measure as the disease progresses. It is a short of Angina Pectoris. Here I have seen Hydrocyanic Acid and its alkali Cyanide of Potassium giving speedy relief, while Cuprum Met and Arsenicum failed. The choleraic discharges went on unchecked, and required ulterior medication but the distressing pain was relieved.
As a point of further similarity between the drug`s action to cholera, I may quote here, from Dr. Hughes’ `Pharmacodynamics’ the following passage: There is good evidence of the action of Hydrocyanic Acid on the solar plexus. Sir B. Brodic applied one drop of the essential oil of bitter almonds to his tongue. He immediately felt a remarkable and unpleasant sensation at the epigastrium, with such weakness in the limbs and loss of power in the muscles, that he thought he should have fallen. And Dr. Hughes continues: I have frequently removed by it the distressing feeling known as sinking of the stomach, when this has been unconnected with the climacteric age. And further on: The curative power of Hydrocyanic Acid in pain at the stomach and vomiting must also, I think, be traced to its homoeopathicity thereto. `An overdose,’ writes the late Dr. Elliotston, `will in every person occasion nausea, vomiting, and pain and tightness at the praecordia.
Even applied externally, it has caused nausea, vomiting, vertigo and syncope.
When I say that, theoretically speaking, Hydrocyanic Acid should be eminently useful in the first stage of the spasmodic variety of cholera, it is hardly needful for me to remind you, that I include within the spasmodic variety of cholera, not only cases characterized from the beginning by spasms of the voluntary muscles, but also such as are marked from the outset by arterial spasms. This would greatly the drug`s usefulness, in fact would place it on an equal footing with Camphor.
I can offer no clinical experience in support of what I have stated, as far as my own experience is concerned. In fact, it was only while preparing these lectures that it dawned upon my mind that Hydrocyanic Acid is a close similar to Camphor, and should, therefore, be as useful at the onset of certain cholera varieties as Camphor itself has proved to be. Evidence can, however, be brought to bear on the subject from other quarters. Pereira looks upon the acid as a sort of specific remedy in gastrodynia. He reports a case of a lady who suffered for months and was permanently relieved, as by charm, and adds: It can hardly be imagined that irritation of the stomach can be rapidly removed by a substance which is itself an irritant. He further relates the case of a gentleman who, after an attack of ague, suffered for several months from excruciating pain in the bowels commencing daily about two o’clock and only ceasing at night; the patient was advised to take Hydrocyanic Acid; the first dose arrested the pain and there was no relapse.
All this goes to show, that in many a case, the drug just mentioned has even a larger sphere of therapeutic action in the spasmodic variety of cholera than Camphor. But Pereira goes even farther; he actually commends this acid in English cholera and says that he has often seen it cure severe forms of this disease, after Opium had failed. Pereira’s statement seems to find corroboration in the fact, that Chlorodyne-a secret preparation, known to contain Hydrocyanic Acid and Opium as its chief ingredients,-has no doubt helped to check the premonitory symptoms of cholera in a large number of cases. The preparation is almost everywhere in India to be found in plantations, in out- of-the-way-factories, etc. and I have heard it spoken to with the greatest praise. Of course, it is the Opium which for the greatest part does what good has been derived from it; the Opium which has a great and prompt effect in checking the progress of the disease, when taken at the very commencement, and which is almost sure to kill where it does not cure; nevertheless the fact that we see here Opium combined with the acid, goes to show that in the experience of the concoctor of the preparation, the addition of the acid must have resulted in a larger number of relief, than where the Opium alone has been used. Chlorodyne may then be looked upon as a partial proof of Pereira’s ascertion to the effect, that Hydrocyanic Acid has proved itself to be serviceable in English cholera where Opium had failed. Let me here mention in passing that there is a place in the homoeopathic treatment of cholera for Opium whenever we can with good reason trace the attack of cholera during an epidemic to fear of catching the infection, or to a general panic, or in cases where the patient gets so frightened at the very onset of a diarrhoea or cholera attack, that the fright prostrates him more than the disease. Opium at the beginning or as an intercurrent remedy will be of great service, it might even be indispensable. Aconite should also be thought of under such conditions. The choice between the two remedies should be made according to the symptoms. Another remedy worth mentioning here is Asarum Europ. It is drug corresponding to a nervous constitution. In such patients the hyperaesthesia may be so great that a second impression of the same magnitude as that received first, will have no effect. Coming back to Hydrocyanic Acid we find Dr. Hempel in his `Materia Medica and Therapeutics’ says: Our provings do not point to Hydrocyanic Acid as a remedy for cholera. This agent may cause vomiting and cramping pain in the bowels, but, in the case of Joerg’s provers, this pain was not associated with any urging to stool. On the contrary the tendency of the drug seems to be to limit the alvine secretions. If diarrhoea does occur as one of the effects of this agent, it is most probably in consequence of some peculiar idiosyncrasy in the patient’s constitution. In Pereira’s case the acid was probably used upon the principle of palliative antagonism.
After what you know about the drift of my argument on the subject, it is hardly necessary to tell you why I cannot agree with the late Dr. Hempel. He had evidently had no opportunity of seeing cases belonging to the spasmodic variety of cholera; he, therefore, rightly pronounced Camphor to be of no use in cholera, even in its first stage; and with the same reason he extended his judgment over Hydrocyanic Acid. We have, however, good reason to believe that the drug will prove, when indicated, as useful as, and perhaps even more than, Camphor. I believe, moreover, that it is owing to a certain routine, into which we have allowed ourselves to fall in matters concerning the homoeopathic treatment of cholera, that we have not yet tried the acid mentioned, at the premonitory stage of spasmodic cholera. It appears as if Hahnemann’s instructions had actually the effect of blocking the way to all useful suggestions concerning the premonitory stage of cholera. He had recommended Camphor, and Camphor is to be exclusively administered in that stage. Even if it were true, as Hahnemann asserted, that, provided Camphor be timely administered, not one amongst hundred would die; even then there would be room for Hydrocyanic Acid to save that most unfortunate hundred and first. But subsequent experience has but too clearly shown, that Hahnemann was too sanguine on the subject. We have yet to learn the existence of a drug that would invariably prove useful in all cases of a certain stage of a certain disease, be that stage even the premonitory stage. In most cases a certain degree of similarity between drug action and disease is sufficient for all therapeutic purposes. But there are cases, or let us say patients, where the usual amount of similarity is not sufficient to satisfy the therapeutic rule of similia similibus curantur; another drug may just contain in its pharmacodynamics all that is wanted to complete the analogy. And so I have no doubt that of the cases unaffected by Camphor, there will be some that would be beneficially affected by Hydrocyanic Acid. As already said before, I am unable to give you any clinical indications which could guide you in your choice between the one drug and the other; the similarity in all essentials between them seems to me to be perfect, and it would not be fair on my part to fix on some minor points of symptomatology, just to establish what has been called a distinction without a difference. I have thrown out some hints in this respect, in the course of this lecture; the rest must be left to future clinical observation.
