Let us never forget, that neither Camphor nor Hydrocyanic Acid inflicts any permanent injury upon those who have come out safely from the effects of their respective poisoning; while an Arsenical poisoning, even if safely escaped from, as far as death is concerned, leaves often long-lasting, if not permanent, injuries behind; it stamps its subjects for a considerable time, with an indefinite train of sufferings and susceptibilities to sufferings, peculiar to its own sphere of pharmacodynamic action- it creates in them a certain dyscrasia. Such drugs as Camphor, Hydrocyanic Acid, etc., are therefore likely to be found to act therapeutically best, in subjects afflicted by cholera, who have in all other respects kept a fair amount of good health. It is evident that in such subjects the impulse towards restoration to health is far more likely to be followed by the desirable result, than in a subject of a broken down constitution. Thus it comes that we shall often find both Camphor and Hydrocyanic Acid fail in cholera for no fault of theirs, if I may say so, but simply on account of various constitutional shortcomings of the patient. And if those constitutional shortcomings should happen to correspond to an Arsenical dyscrasia, then we may expect with a fair amount of confidence that Arsenic will help, where such a remedy as Camphor or Hydrocyanic Acid or indeed any otherwise pathologically indicated remedy would have left us in the lurch.
All subjects tainted by chronic malarial cachexia, may be said to be inflicted with a dyscrasia similar to the Arsenical poisoning. The signs by which a malarial taint manifests or may manifest itself are numerous. Febrile movements, paroxysmal or periodical, not to be accounted for by exposure to cold, etc.; various digestive disorders especially when characterised by a sensation of burning in the stomach; periodic nervous disorders, or any disorders dating from a previous age-all such conditions should draw our attention in the treatment of spasmodic cholera to Arsenic, in preference to Camphor. Camphor rarely benefits such subjects, and if it does, it does so partly only, and we are after all driven to Arsenic-often when it is too late. We cannot expect much in such cases from a preventive treatment; we require here a curative remedy, and such a remedy we possess in Arsenic, which has besides a potent, and by far more permanent influence upon the vaso-motor nervous system than Camphor.
For reasons already stated before, Arsenic may be superseded by some rival remedy at the beginning of a choleraic attack; but even there it will be a potent, if not an indispensable, auxiliary remedy. In fact there is no variety, nor any stage of cholera, in any of its varieties, where Arsenic might not be urgently called for, were it only as an auxiliary, and symptomatically indicated remedy. Great restlessness and anxiety, coupled not merely with depression, but with utter prostration and hippocratic face, are strong indications for Arsenic. A strange mixture of irritation and prostration is one of the great characteristics of our drug. Should the stomach particularly be the seat of such irritation, then Arsenic is so much the more remedy to be administered. Gastric irritation is, of course, present in all cases of cholera; but sometimes it forms the chief feature of the whole disorder, to such an extent, that pathologists speak of a gastric variety of cholera. There is severe and almost continual retching without much vomiting; patient dreads taking water, though tormented by burning thirst, for fear it might not agree; drinks rather little at a time but often, and what is drunk is almost immediately thrown up; in such a contingency you can hardly do better than prescribe Arsenic either alone, or in alternation with some other suitable drug, called for by the peculiar nature of the choleraic phenomena. If Arsenic does nothing else, but allay, be it even temporarily, the gastric irritation, so as to allow the absorption on the part of the patient, of the remedy we consider to be indicated, then it has done enough for us. It has paved the way to proper treatment.
In all cases of diarrhoeic cholera we should, at the beginning of our treatment, take into consideration the nature of the diarrhoea which preceded the choleraic attack. The very fact that the diarrhoea has run into cholera would speak favourably for the choice of Arsenic at the very onset of choleraic stools. Sometimes we find in this way the right clue to the remedy. Should the diarrhoea itself have been of such a nature as to have pointed to Arsenic as the homoeopathic remedy, then the similarity of the case to arsenical poisoning would be perfect. The characteristic Arsenical evacuations may be summed up in the following: Stools in small quantity, frequent, dark, greenish, bloody, offensive; sharp pain in the lower part of the abdomen; burning in the rectum; great prostration of strength after each stool; aggravation at night, especially at midnight; great thirst (especially at night); drinking but little at a time; restless (especially at night) and anxious. Should such a diarrhoea have been brought on by taking ice in hot summer, or in consequence of having partaken of some animal food, there would be one more indication for Arsenic.
Local conditions may sometimes determine the choice of Arsenic; thus a diarrhoea preceding cholera brought on by dwelling in damp places, may, under tropic influences, assume an asthenic type, as above described, and require the exhibition of Arsenic, and so may the cholera succeeding the diarrhoea, although choleraic evacuations in themselves by no means resemble those ordinarily occurring under toxic influence of the drug. Again cholera breaking out at places where putrid animal matter has been allowed to infest the air, may require Arsenic, regardless of the cholera type prevailing. I shall read to you what I wrote some years ago about the subject.(* Monthly Homoeopathic Review, May, 1871*). In perusing the lately published Manual of Medical Jurisprudence of India, by Dr. Norman Chevers, a homoeopathic physician may derive some useful information. The following passage is interesting and suggestive :- Dr. Kanai Lal Dey (Additional Chemical Examiner to Government) informs me that the washings of stinking fish, and human ordure, are used by the natives of Bengal as emetics in cases of poisonings. In a case of Arsenical poisoning, which occurred lately at Tipperah we are told that the symptoms were not relieved until the man swallowed some human faeces. Considering the analogous effects on the human system of putrid animal matter and Arsenical poisoning (the analogy is not mine, but Dr. Christison’s), considering further the clinical fact that Arsenic has proved a potent antidote to the consequences of taking putrified animal matters, we may find in this statement something more than a mere curiosity; we may seen in it, a strange confirmation of our law of cure.
After what you have heard about the relation existing between the malarial cachexia and the effects of Arsenic on the one hand, and of the similarity of the latter to cholera on the other, you will hardly be surprised to learn that, for all we know, Arsenic should be the leading remedy in that peculiar type of cholera, described in a previous lecture as choleraic fever. Study Elaterium. Natrum Mur. and as a matter of mere suggestion, I should say Nat. Arsenicum might be given a trial in some cases. Veratr. Alb. and Veratrum Viride are two other remedies bearing upon the subject. Compare also Arsen. Hydrogenisetum. I cannot speak from experience on the subject; I am guided in what I say, by analogy. In cholera outbreaks following in the track of a famine, I should think, Arsenic must also play an important role with regard to treatment; here also I can, however, speak only by way of suggestion. Again cholera occurring after obstinate constipation, or in people suffering from habitual constipation should have a fair trial with Arsenic. The retained faecal matter in the organism gives rise to what has been called Coproemia, this is, a state of blood infection by the exhalation of the retained faeces as they permeate all the liquid and solid of the body, the blood especially.
If after all what we have learnt about the pharmacodynamic action of Arsenic, we should venture to enquire which are the absolute, and which are the contingent effects of the drug so often mentioned, then there could only be one answer, I believe, as to the absolute effects of Arsenical poisoning; it is namely, the collapse produced by it. The drug may act in some subject as an irritant to the digestive canal, exciting there active inflammation; in others as a powerful narcotic, producing coma; in a third like the poison of cholera- the scene invariably closing with collapse as it occurs in cholera. And herein lies the great similarity between Arsenic and cholera. In both, the primary morbid phenomena set up by their respective toxic agents may vary; they may begin in the one case or in the other, with arterial and muscular spasms first tending toward diarrhoeic discharges; or the succession may be reserved: the final issue is everywhere the same-collapse. Collapse is the common characteristic of both poisons.
