Drugs



It has been observed, and rightly observed, that the action of Hydrocyanic Acid is too evanescent and temporary in its character. I have myself often seen a flickering pulse of a cholera patient in the state of collapse gaining strength and apparent stability in a comparatively short time, say two or three minutes, from the administration of the drug; but the improvement lasts almost no longer than the time required to set it up. The dose would then be repeated, or even increased; there would again be some improvement for two or three minutes; then the medicine would gradually lose its effect altogether. I am happy to say, since I have substituted the Cyanide of Potassium to the acid, I have met with far better results in this respect. Many a case, that to all appearance gradually slipped out of my reach under the administration of the acid, was brought back to permanent improvement under the more steady influence of the Cyanide of Potassium. I carry with me the second and third decimal, and the third centesimal trituration, and begin as a rule treatment with a grain or two of the third decimal. Should you ever have the opportunity of trying Hydrocyanic Acid in the premonitory stage of spasmodic cholera, I would strongly advise you not to rest, in the case of failure, till you have substituted the Cyanide in the place of the Acid.

The next remedy I have to speak of in connexion with the spasmodic variety of cholera is, the second analogue to Camphor, or what I consider as such, Arsenicum Album. The similarity between the toxic effects of this drug and cholera is so well- known, that in many places of this country where criminal poisoning frequently occurs, the police authorities have been induced to issue instructions to their subordinates, drawing their attention to the great similarity of Arsenic poisoning to cholera, and instructing them at the same time how to differentiate between the two. The character of the evacuations is pointed out as one of the essential points of difference : in cholera they are colourless, odourless, rice-water like; in Arsenical poisoning, there is blood present in the stools, whether they are faecal or liquid; again the stools are greenish or blackish, and more or less fetid. In the later stages of Arsenical poisoning the characteristic rice-water stools of cholera may be present (A Text Book of Medical Jurisprudence for India by I. B. Lyon, F.C.S., Calcutta and London 1889, p. 144), and in the case they are liquid, they are sure to be colored, greenish or blackish, and, in some cases fetid. When the subject can only be seen at a stage of collapse, a stage where, even when due to cholera, vomiting and purging are as often absent together, then a distinction is almost impossible, and almost nothing else remains, in the case of a fatal issue, than to have recourse to the chemical examiner. There is yet another distinction between Arsenic poisoning and cholera, a distinction referring, like the previous one, to the stage preceding collapse; namely, that in Arsenic poisoning there is often febrile excitement at the beginning, while in cholera it is, as we know, all but the reverse. This distinction, however, does not hold good in all cases; for there are cases of Arsenic poisoning, which begin with difficult respiration, coldness all over and spasms-in short with all the symptoms peculiar to the first stage of spasmodic cholera. This is not an invariable effect of Arsenic; and its homoeopathicity to the first stage of spasmodic cholera cannot, therefore, compare with the homoeopathicity of Camphor of Hydrocyanic Acid to the same stage and variety. I should say, the spasmodic effects of the two drugs just mentioned are absolute; while those of Arsenic are, what Dr. Drysdale has called, contingent, that is to say drug-effects which, in order to be produced, would require a subject of special susceptibility.

Such contingent drug-effects are just as useful, for therapeutic purposes, as the absolute ones, provided you find a subject specially susceptible to the drug’s action. Suppose an individual is particularly susceptible to such Arsenical effects as I just before called contingent, suppose such an individual to be effected by spasmodic cholera;; then you could not do better, than to administer to him Arsenic in homoeopathic doses, in the same way as you would proceed in the generality of cases with Camphor, or with Hydrocyanic Acid. More than that. In the case of such patients you might often, to your surprise, partially, or even totally fail with your usual remedies, whose therapeutic actions are derived from their absolute effects upon the healthy, and from the similarity of those absolute effects to spasmodic cholera. It would appear, as if such patients could be relieved by nothing else, but by the remedy with regard to which they have so prominent a degree of susceptibility. Homoeopathy teaches us how to find out, who are the patients particularly impressed by a certain drug, and consequently to whom it is most likely to be helpful. I shall come back in the course of this lecture upon the particular indications calling for the administration of Arsenic, in preference to Camphor or Hydrocyanic Acid, in the first stage of spasmodic cholera.

As to the absolute effects of Arsenic poisoning, I shall quote here Virchow’s statement: Arsenic, in doses large enough to induce acute poisoning, acts as an irritant to the whole digestive canal, exciting very active inflammation in its delicate mucous membrane; accordingly the symptoms to be expected from severe inflammation of this tract set in. But strange to say, the symptoms following a large poisonous dose are not invariable; the symptoms arising from acute inflammation of the digestive canal are most common, and prove fatal in four or five days; but sometimes these symptoms are almost or entirely absent, and instead of the patient running the usual course of Arsenical poisoning, profound coma sets in from which he never awakes, but dies in a few hours, the mucous membrane of the stomach and intestines being free from all inflammation. Sometimes the symptoms are very like those of English cholera.

From Dr. Ringer’s Handbook of Therapeutics I quote a statement from Dr. Blachez, who describes another form of Arsenical poisoning characterized by choleraic symptoms of the intestinal canal, with suppression of urine, cramps, and progressive coldness of the body, convulsions and localized paralysis especially attacking the extensors. If the patient survives long enough, a petechial, papular, vesicular or wheal- like rash often appears from the second to the fifth day. To which Dr. Ringer adds the following : A fatal dose of Arsenic lowers the temperature of dogs and rabits 4 degree to 7 degree F. It is besides well-known and fully established that Arsenic lessens the carbonic acid of respiration.

Strange to say, in the toxicological effects of Arsenic we do not only find a fair representation of the general outlines of cholera; even to different varieties of cholera, as described before, are to be met with in the different cases of Arsenical poisoning.

Take the following case, recorded in the Lancet 1847, P.44, by Dr. Letheby:-A girl, 19 years of age, took at night 2 oz. `fly-water,’ containing 2 grs. white Arsenic. Some restlessness during the night, with watchfulness and slight pain in the stomach. In the morning she became sick, and complained of great thirst; the pain in the stomach had become much more intense. During the day sickness increased, and she was repeatedly purged; countenance looked pinched and extremities cold. From this state she soon rallied, and next night she became cheerful and slept comfortably, though she was distressed once or twice by the thirst, which still affected her. Thursday morning she was worse, being cold and drowsy; she was evidently dying; face pale and anxious, extremities cold and bedewed with clammy sweat; pulse hardly perceptible, and she lay in a state of incipient coma. From this time (9 o’clock) she became more comatose, and gradually sank at 12.

Or the following, from the Edinburgh Medical Journal 1858, Vol III P. 391, as reported by Dr. Robert Paterson:-

She was found in bed early in the evening suffering much from sickness, vomiting and purging. Continued to get worse all night. Next morning the symptoms were much like those of cholera, except that the vomited matter was like thin coffee grounds. She was extremely sullen and silent, would not answer any question, and would rather suffer thirst than ask for drink. Pulse feeble, tongue white, epigastrium tender. Next day symptoms much aggravated. Countenance had assumed a sunken aspect and dark leaden hue. Everything taken into the stomach was immediately rejected, and the purging was also frequent, with pain and straining. This state continued with little variation till next morning, when she died convulsed, sixty hours after the first symptoms were noticed.

This could be taken as a fair specimen of the non-spasmodic variety of cholera, if we choose to close our eyes to one essential, differentiating fact, namely that the dejections have not been what they are in genuine cholera viz. rice-water like.

Leopold Salzer
Leopold Salzer, MD, lived in Calcutta, India. Author of Lectures on Cholera and Its Homeopathic Treatment (1883)