Considering that the spasmodic variety of cholera, in its genuine type, is rather rare now-a-days, it must have appeared to many of you, that too much time has been taken up with the consideration and analysis of remedies which are in the first instance more or less calculated to act as antispasmodics. Knowing however as I do, how important the spasmodic element is in all cholera varieties, I do not think we could well afford to dispense with any of them. Coming now to the diarrhoeic variety of cholera, we are delighted to meet, for the first time, a drug the physiological action of which is perfectly homoeopathic to cholera. I speak here of a drug which is almost unknown in homeopathic practice, which is, however, nevertheless destined considerably to advance our cholera therapeutics. It is Ricinus I am going to entertain you about, during this lecture. The drug is prepared from the seeds of the castor oil plant, and shall be called simply Ricinus, in order to distinguish it from the oil the well-known Oleum Ricini of the old school.
We have to thank Dr. Hale of Chicago for having first drawn our attention to this drug. I am amazed, he says in his `New Remedies’, that Hahnemann, or some of his contemporaries, did not institute provings of the seeds. They must have been aware of their poisonous action. Knowing its botanical relationship and the almost universal use and abuse of the oil, it is surprising that Ricinus did not, in their hands become a polychrest. It is certainly as capable of occupying such a place as Euphorbia, Jatropha, Croton Tiglium, or Veratrum.
It ought to be useful in Cholera Asiatica, Cholera Morbus and Cholera Infantum. It will doubtless prove a specific in many cases of mucous enteritis in the form of diarrhoea and dysentery.
I am happy to tell you, gentlemen, that after having been put by me to a practical trial for the first time this year in Calcutta it has really proved to be, what Dr. Hale predicted useful, very useful indeed, in the diarrhoeic variety of cholera. This is so much the more agreeable, since we have hitherto not possessed one single remedy which could have pronounced similar effects with regard to abnormal evacuations to those occurring under the influence of cholera. Veratrum Album was our sheet anchor in such cases; but how different are the ejections brought on by the toxic effects of that drug, from those of a cholera patient! It is true, under the action of Veratrum the alvine evacuations are as rule serous-a great advantage over all the other drugs previously mentioned; but they are at the same time bilious, while choleraic evacuations are characterised by total absence of bile. Veratrum lacks also the suppression of urine, so pathognomic of cholera. Again in the diarrhoeic variety of cholera vomiting and purging set in without colic; the same gradually appears, in the measure as the evacuations become profuse; while the toxic influence of Veratrum, the diarrhoea is almost invariably associated with colic. Is it a wonder after this that we have hitherto so badly done in cholera? With a wrong impression about the therapeutic use of Camphor, and with no suitable remedy for diarrhoeic cholera, we could hardly have done better than we did. I consider an average loss of 26 per cent.
in an acute disease like Cholera a very poor clinical result with a therapeutic system like Homoeopathy to work upon. It is of very little consolation to us to know that under any other therapeutic system the result has been by far worse.
Again I say I am happy to inform you, that in Ricinus we possess a remedy which is, in diarrhoeic cholera, what Camphor was in the hands of Hahnemann and his followers in the spasmodic variety.
As the use of the drug is altogether new in our school, I shall lay before you all what is known of it. In doing so I avail myself of the labours of Dr. Hale and Dr. Allen.
I quote first from the `New Remedies of the first mentioned author:-
As the oil probably derives its purgative action from the principle which renders the seeds themselves so harsh and even poisonous, it may be well to describe their effect more particularly. M. Mialhe proved that an emulsion made with the kernels of the seeds is violently emetocathartic in the dose of one hundred and fifty grains (from seven to ten seeds), and that even a tenth part of that quantity produces both vomiting and purging. He hence inferred that the active principle of the seeds is yielded but slightly to those varieties of the oil which are obtained by pressure alone, without heat. This is more fully proved by instances such as the following: Giacomini relates that when a child he experienced a violent attack of vomiting and protracted exhaustion from eating nine or ten of the seeds. Bergius records the case of a man in full health, who ate a single seed of ricinus which, however left an acrid taste in his mouth. Early in the next morning he was seized with violent vomiting, which continued alternately with purging throughout the entire day. Lanzoni saw a young woman attacked with violent cholera morbus, with excruciating pain in the bowels, from eating three of the fresh seeds. Dr. Taylor records a fatal case of poisoning from this cause. Three young women ate of the seeds, one about twenty of them, another four or five, and a third two of them. Upon the two latter persons the effects were those of a violent cathartic, but the first was seized with vomiting and purging, and looked like one in an attack of malignant cholera; the skin was cold, pale and shrunken; there was pain in the abdomen, and the mind was in a drowsy, half conscious state. The dejections consisted of bloody serum. No reaction took place and death occurred within twenty four hours. On examination, the gastro-intestinal mucous membrane was found to be abraded and inflamed. A soldier in Algeria is said to have died from eating only three castor oil seeds. The whole intestinal mucous membrane was found after death coated with blackish blood. The lining membrane of the stomach was somewhat reddened and softened.
A case is related by Bergius where only one seed produced symptoms of poisoning; namely, nausea, vomiting and diarrhoea.
After twenty seeds, gastro-enteritis and death, preceded by convulsions and general collapse.
A young and strong man, after eating two grains of the seeds from which the oil had been expressed, was seized with such violent vomiting that his life was in danger.
The following case of poisoning by the seeds shows something worse than mere enteric inflammation, for they appeared to cause albuminous urine and jaundice.
Bean, a sergeant in the 7th company of Engineers, entered the hospital at half past five July, 10, 1871. He ate the same day in the morning, some Ricinus seeds as a purgative. The seeds were perfectly ripe, dry, and gathered in the fall of 1869. As he did not find the taste very disagreeable, he ate seventeen of them. No accident happened immediately after eating them, and he took some beef-tea with appetite. Three or four hours afterwards he passed several loose stools and suffered afterwards from pyrosis, cramps in the stomach and nausea, followed by vomiting. The stools became at the same time more numerous and copious, and were passed without tenesmus or colic; formed of serous liquid mixed with mucus. About 4 p.m. the diarrhoea became incessant, with cramps and chilliness; at 5 p.m. he entered the hospital.
Pathology. Present state: pale face, the forehead covered with cold sweat, and features drawn; the eyes are convulsed and drawn upward in the orbits, the conjunctivae injected and copious lachrymation; the pupils only moderately dilated; pulse normal in frequency, but so small, that sometimes it can hardly be felt at the radial artery. Intelligence perfectly clear; patient complains of headache, vertigo buzzing in the ears and a sensation as if a bar laid his stomach with profund anguish; burning thirst; pyrosis nausea vomiting; the vomited matter is fluid, lightly colored by some bile and holds some glairy filaments suspended epigastrium very sensitive and the pains radiate towards the navel and hypochondria; neither light nor strong pressure aggravates the pain, at the same time the patient feels a sensation of violent constriction in the intestines; the diarrhoea becomes colliquative, and the stools look like those in cholera. Complete anuria since 10 A.M,; voice very veiled; profound adynamia; it takes two persons to hold the patient.
The time for antidotes has passed and only indication remained to combat the coldness the muscular to combat the coldness the muscular contractions, the stoppage in the circulation in one word to remove the pseudo-choleraic symptoms consecutive to the enormous loss of water the patient had sustained. Frictions with camphor were ordered, sinapisms(* Sinapism = A mustard plaster*). to the thighs, and hot flaxseed tea given in large quantities. Antispasmodics could not yet be given on account of constant vomiting.
