The patient is to get one or two globules of the finest preparation of Copper (prepared from metallic copper in the mode described in the second part of my work on Chronic Diseases), thus Cuprum 0, 00, X, moistened with water, and introduced into his mouth every hour, or every half-hour, until the vomiting and purging diminish, and warmth and rest are restored. But nothing else at all must be given beside; no other medicine, no herb tea, no baths, no blisters, no fumigation, no venesection, etc., otherwise the remedy will be of no avail. similar good effects result from the administration of as small a portion of White Hellebore (Veratrum Album. 0,00, x). But the preparation of copper is much to be preferred, and is more serviceable, and sometimes a single dose is sufficient which is allowed to act without a second being given, as long as the patient’s state goes on improving.
The wishes of the patient of all kinds are only to be indulged in moderation. Sometimes, when aid is delayed many hours, or other and improper remedies have been administered, the patient falls into a sort of typhoid state, with delirium. In this case, Bryonia 00, X, alternately with Rhus Tox. 00, X, proves of eminent service.
What strikes us most forcibly in these instructions, is the absence of all individualisation. Camphor is to be used first, and if camphor does not succeed, then Cuprum is to be administered, and similar good effects result from the administration of as small portion of Veratrum Album. This want of individualisation is so much the more felt, as cholera is a disease so variable in its manifestation as almost to defy any conclusions drawn from previous observations. In Ziemssen’s Cyclopaedia of the Practice of Medicine we read that almost every epidemic in Europe has its own peculiar physiognomy, that it varies markedly in intensity and extent in different localities, that it often begins with the lighter forms and then passes into the graver, which may then prevail to the end; but it may also prevent a high mortality from to start and that in the same epidemic there is such a complexity in the manifestation and course as can scarcely be exhibited in the most faithful description. After this it is surprising that with the small number of homoeopathic remedies hitherto at our disposal we have done what we did. (For particular modes of cholera see a description in Arndt’s book, Article on Cholera).
This absence of individualisation on the part of Hahnemann and his followers has no doubt greatly helped to facilitate, and, as a consequence, to introduce and spread the homoeopathic treatment of cholera. But what has proved thus far our strength, must on the other had often have proved itself to be one of the greatest shortcomings in the result of our cholera treatment.
When we remember, however, under what circumstances the rule of the cholera treatment had been pronounced by Hahnemann, we shall find that our master could hardly have acted otherwise than he did. Hahnemann, by the time cholera had reached Europe, lived in Coethen, secluded from the world, a self-made prisoner, in order to avoid as much as possible any contact with a world that had nothing but ridicule, for a discovery, destined to revolutionise the whole science of medicine. His disciples, before they even had the opportunity of seeing a case of cholera themselves, and simply on the strength of what they could learn from hearsay of the nature of the disease, then entirely new to Europe, had asked him, how they have to behave in the case the spreading epidemic should reach their abodes. Hahnemann, under the circumstances did what he could; he pointed to the drugs most likely to be useful in the cholera type described to him, leaving to be useful in the cholera type described to him, leaving individualisation and eventual addition of other drugs, to them who may have close opportunity for observation. That neither the one nor the other had been attempted by his disciples, who evidently had availed themselves of their master’s suggestions, can best be judged from the tenor of the above quotation, in which indications are not wanting to show that the same must have been written after confirmatory clinical experience had been gathered by the writer.
Nevertheless, as it is, Hahnemann has left us a most graphic description of two cholera varieties prevalent at his time. The one was what we would call now-a-days malignant cholera, the other spasmodic variety of cholera. In these varieties and particularly in the latter it is not so much the blood as the nervous system which is primarily impressed by the cholera- poison. The evacuations, at the very onset of disease, are not necessarily void of all traces of bile; at any rate cholera is fully established before the discharges have assumed the ricewater character. Death may actually take place before the manifestation of any choleraic evacuations, simply in consequence of spasmodic contraction of the arteries, especially of the minute pulmonary arteries, whereby the circulation of the blood is impeded.
As to the action of the heart in the first stages of the spasmodic of cholera, that is to say the stages preceding collapse, it may best be described in the words of Surgeon-Major A. R. Hall of the Army Medical Department, who happened to have an attack of cholera himself. While my skin was blue and cold, he says, and while no pulse could be felt at the wrist, the heart was beating more forcibly than usual. And then he continues: The heart and all the arteries in the body are in a state of spasmodic contraction; the muscular walls of the heart, therefore, work violently and squeeze the cavities, so that the whole organ is smaller than it ought to be; but it cannot dilate as usual, and so cannot receive much blood to pump to the wrist. Of course this description would not suit the state of collapse; for in that state the heart shows unmistakable signs of exhaustion.
Malignant or spasmodic cholera attacks people in good health; there is a rule, no premonitory diarrhoea. In India, where the spasmodic variety is rather the exception than the rule, the premonitory symptoms are vertigo and noise in the ears, the latter sometimes so loud, as to have been compared to the humming of a swarm of bees, to the beating of drums in the camp, or to the roaring of the surf as on the Coromandel Coast (Aitken).
Both the premonitory symptoms- if there are any-and the phenomena manifesting themselves during the first stage of the spasmodic variety of cholera, strongly point then to a neurotic disorder. I do not mean to say that the blood in the first stage of the spasmodic variety remains in a healthy, normal state. For the venous congestion which must necessarily ensue in consequence of the phenomena above described, cannot fail to render the blood charge with an abnormal amount of carbonic acid, and as such, more or less unfit for the maintenance of life at a normal rate. But there are not the slightest reasons to suppose that the blood is primarily affected in the spasmodic variety of cholera. Even the discharges from mouth and rectum, so peculiar to cholera, manifesting themselves at the further stage of the disease, do not directly point to a primary haematic disorder; for it can easily be shown that such disorders are traceable to a disturbance of the vaso-motor nerves. It appears, says Dr. Goodeve, that at least two great sets of capillaries and small arteries are involved in the effects of cholera poison, those of the lungs and intestines. They seem to be very difficulty influenced by it. In the lungs very little of the blood passes freely through them. In the intestines an enormous quantity of certain of the blood elements passes through the capillary walls in the exudation period. In both of these sets of action, parts of the nervous system appear to be under the morbid influence. In the lungs the muscular fibres of the small arteries seem thrown into a state of contraction. In the intestines a sort of paralysis of the smaller arteries and capillaries seem to exist, such as occurs in the section of the sympathetic nerve in the neck in Claude Bernard’s well-known experiment. That the morbid action in the lungs is of nervous character seem probable from the absence after death of any discoverable mechanical obstacle to the passage of the blood; from the paroxysmal nature of the Dyspnoea at first, and from the ease with which the pulmonary circulation is re-established when recovery begins.
Coming back in the course of his discussion upon the same subject, Dr. Goodeve remarks:- The nervous character of the action in the intestines seems probable from its analogy with the result of Claude Bernard’s experiments on the sympathetic, in some of which a section of that nerve in the neck caused the surface of the skin supplied by the vessels under its influence to manifest a considerable increase of the flow of blood, and to become at the same time bathed with sweat.
