Another specimen of Arsenical poisoning of the same order we find in the Boston Medical and Surgical Journal Vol. XIII., 1835, P. 334 :-
A man, 23 years of age, vomiting in the course of half an hour; soon afterwards several dejections. Vomiting and purging, at short intervals, continued through the day. Evacuations consisting mostly of a serous fluid and bile. Quantity vomited during the day amounted to six to eight quarts by estimation. In the afternoon, on attempting to walk from one bed to another, he fell down senseless, was convulsed, had cramp in extremities, and was cold. At 7 in the evening, seventeen hours after the occurrence, I found him as follows: Extremities cold, bathed in perspiration; skin blue and corrugated, feeling as if parboiled; no pulse perceptible at wrist; pulsations of carotids rapid and fluttering; eyeballs retracted in orbits; countenance livid; voice husky and guttural; extreme thirst : pain at epigastrium; frequent vomiting; mind clear; whole appearance like that of a person affected with malignant cholera. Cramps and coldness of extremities increased, vision failed, voice faltered, throat become dry, tongue swollen, annoyed by hiccoughs, delirium, and at last death.
I shall give you now a case strongly resembling the spasmodic variety of cholera, bearing always in mind the difference in the nature of the dejections. The case is reported by Dr. Hicks, in the Lancet, 1870, P. 356 :-
A man, aged forty-eight years, was engaged in pulling off (arsenicated) wall paper. After about twelve hours, he suddenly felt great difficulty in breathing, with cramp in the chest, hands and arms; immediately afterwards the cramp attacked both calves, and he became very cold all over and stiff, so that he became completely helpless, and had to be entirely lifted into bed. Violent vomiting very soon set in, and the cramp became more severe in the calves, though it did not again affect the chest and the calves, though it did not again affect the chest and arms. The breathing, however, continued to be much oppressed for two hours. He was by this time in a state of great prostration; countenance strangely anxious, and very restless; skin cold and clammy; pulse very feeble and frequent; eyes deeply sunken and surrounded with a well-marked, dark border; lips and tongue parched, great thirst; breathing slow and much oppressed; sometimes sighing; burning pain in stomach, increased on pressure, and inclination to vomit; extremities icy cold in spite of hot applications; had severe vomiting, with griping pain in bowels and purging; also cramps, first in chest and arms, afterwards in calves,…….vomiting of greenish yellow fluid at interval.
After so much similitude between the pharmacodynamic effects of Arsenic and cholera, it would almost appear that we are under an obligation to state, why we use the drug so seldom in our school as a remedy in the first stage of spasmodic cholera. The only reason I can assign for it is this, that we believe, rightly or wrongly, to possess a surer and prompter remedy to meet the case. I must also add that the principle of prevention being better than cure, must also be admitted to have a good deal to do with the mode of therapeutic proceedings we have adopted. Camphor is prompt in its action, and it is definite and absolute in its action invariably producing the same train of symptoms, when the poisonous dose has been large enough to produce its full effect. Of course, Hahnemann was far from viewing Camphor as a drug possessed of definite and absolute toxic properties. Whatever his motives for recommending the drug may have been, foremost amongst them was undoubtedly the consideration, that the rapid action of the drug eminently renders it fit to cope with the disease at its very onset. His advice has been crowned in so many cases with success, that people did not dare to do otherwise but give first Camphor its due chance. Nevertheless I do believe, Camphor would never have attained whatever it has attained in the shape of success, had the drug really been so unstable in its action as Hahnemann represented it to be. Whatever the case may be we know now better. And when the question arises before us: Are we for the future to assign to Arsenic a larger place, than it has hitherto occupied in the treatment of the first stage of spasmodic cholera? Then it is but fair that all what is at present known on the subject, should be brought to bear on the question.
Now as far as our present knowledge goes, we may say that, if we were asked by which way we could in the surest and promptest manner, produce in the healthy a state similar to the first stage of spasmodic cholera, we might hesitate between Camphor and Hydrocyanic Acid; in no way could we, however, reasonably mention Arsenic in connexion therewith. Leaving alone that the Arsenic is comparatively slow in its action, it is altogether variable in the mode of its invading its victims. In certain quantities-and no body can say what that quantity is to be, or may be, in a given case- in certain quantities it is likely to set up inflammation in the digestive canal with high fever, etc.-a state quite different from the primary stage of spasmodic cholera. In some others it may induce profound coma- which is again a state quite different from the primary stage of spasmodic cholera. Should even a state similar to a choleraic attack be brought about by the toxic action of the drug, it would still be doubtful, if the attack is to be one resembling the spasmodic or non-spasmodic variety of cholera. In a word, the Arsenic effects, as far as their relation to the primary stage of spasmodic cholera is concerned, are contingent, while the Camphor or Hydrocyanic Acid effects are, in this respect, absolute. Now contingent drug effects are most valuable in homoeopathic practice, when ever they are made use for the purpose of cure; for such purposes experience has taught that contingent drug effects are often even superior to absolute drug-effects; but the very same experience has taught us, that with regard to preventive purposes on homoeopathic principle, we fare much safer by giving preference to the drug which has the desired toxicological effect in an absolute manner on its side.
If we are then to proceed by trying to prevent the spasmodic stage of cholera from developing any farther, then we shall generally succeed far better with Camphor or Hydrocyanic Acid than with Arsenic. It must, however, be conceded that Arsenic has far greater curative pretension in the spasmodic variety of cholera, than either Camphor or Hydrocyanic Acid; for none of these drugs has any toxic effect which, are far as resemblance to cholera is concerned, goes beyond the spasmodic stage; while Arsenic runs, so to say, on parallel lines with cholera through all the stages. In fact, were it not that the dejections in Arsenical poisoning are never rice-water like at the beginning while they are so in cholera, we should have in Arsenic a perfect cholera-simile.
Now in the non-spasmodic variety of cholera, where our therapeutic efforts must be directed from the very beginning, towards checking the choleraic secretions, it would be a great mistake indeed, to expect anything in the shape of cure or even prevention from Arsenic. The existence and nature of the evacuations are here of primary importance; and the nature of the alvine evacuations in the case of Arsenical poisoning are, as a rule, not serous. They are small, soft, bloody and bilious. Kali Arsenicosum, as seen from Dr. Allen’s Encyclopaedia and Supplement, has produced white watery stools from the very beginning and should theoretically be superior to all the other arsenic preparations. Clinical experience I have as yet none. It should be remembered that the cholera evacuations are alkaline, While the common Arsenic we use in the Arsenious Acid. Whether this has any thing to say in the matter I do not know; clinical experience alone can tell. We have, moreover, in our Materia Medica about ten compounds of Arsenic, and should certainly make better use of them in cholera than we do now. Thus Aurum Arsen. (in syphilitic patients); Arsenicum Hydrogenisatum (for inhalation, especially when difficulty of breathing is marked from the very beginning); Antim Arsen. (when the symptoms are between those calling for the one or the other of the elements of the compounds); Bromide of Arsenic (cholera of diabetics); Cuprum Arsenic (of which the text treats further on). Arsenic Iodium (syphilitic patients); Natrum Arsen. (symptoms generally worse in the morning); Chininum Arsenic (Cholera grafted on malarial fever on its consequences, provided patient had not been quininised before); Strych. Arsenic. (Cholera after debauch). In these cases our routine practitioners would give Nux Vom. seldom with any effect, because a choleraic attack is out of the reach of Nux Vom. Strychnine Arsenicum might save time and life. Of course, all that has been said here with regard to the application of Arsenic compounds refers to such cases where Arsenic as such is indicated. Often after cramps and purging have subsided, vomiting, not of choleraic but exceedingly acid type continues, greatly interfering with the process of reaction. I believe this excessive acidity of the vomit is owing to the muscular cramps that preceded, or still partially subsists; know as it is that a muscle in repose is alkaline, but becomes acid when contracting. Now for such vomiting, which, as far as its character is concerned, stands between the Nux Vom. and arsenic-vomiting, we might with advantage administer Strychnine Arsenicum I have further to mention Arsenicum Sulph.; this might be indicated in cholera beginning with diarrhoea for which Sulphur is indicated. Strychnine Arsenicum might also be thought of in spasmodic cholera and its sequences, when Cuprum Arsenicum has failed. Experience alone can teach whether this suggestion is right or not. But in the spasmodic variety there are evidently strong indications for Arsenic as a remedy, on the ground of its being capable of producing in some healthy people a train of symptoms strikingly similar to that variety of cholera. Like all other contingent remedies, it will only be called for in some particular cases; but whenever the homoeopathic indications for its use are pronounced, it can hardly be replaced by any other drug- curative or preventive; at least such is in all likelihood the case, judging from what is generally known in this respect on the subject of therapeutic drug action. Such remedies may even, under some particular atmospheric or local conditions, be prominently indicated at a certain epidemic, or at a certain endemic outbreak of cholera, to the exclusion of all others. Then we hear an outcry against Camphor, and a resolution never to try it again, while at the next village, during the same outbreak, it may be the chief remedy.
