Heat returned but the chief physician, Dr. Teray, ordered, on account of the vomiting, iced drinks, an antispasmodic potion, emollient injections in order to empty out the last traces of the poison, poultices on the abdomen, and continued frictions. The vomiting lasted till 3 A.M.
July 11th Some fever tongue hot and dry anorexia and pyrosis.
Vomiting again; the epigastric and abdominal pains, as well as the diarrhoea continued; more cramps; extreme lassitude; absolute anuria. At 10 A.M. he passed a small quantity of dark colored thick and highly albuminous urine.
July 12th. Fever and diarrhoea continued; cramps in long intervals; severe headache; urine still scanty, with large precipitates by heat or nitric acid. The same treatment.
July 13th. Pulse normal face slightly congested tongue white no appetite, pyrosis vomiting and abdominal pains; moderate diarrhoea, without tenesmus or colic. Icterus fully pronounced. Urine still very albuminous.
July 14th. Some diarrhoea and great lassitude.
July 15th. Only two stools; appetite returned; urine ceased to be albuminous. Discharged.
Some more similar cases are given by Allen in his Encyclopaedia of Pure Materia Medica In one case there are diarrhoea without any pain throughout. Allen emphasises that symptoms, pointing out that it has been verified in practice. From the cases I shall read to you, you will see that painless evacuations form, indeed a characteristic indication for the administration of Ricinus in cholera. Absence of pain at the outset of choleraic evacuations is more than a mere symptomatic indication; the absence of pain is of great pathological significance; it shows that the cholera case we have to deal with, is of a pure diarrhoeic variety, taking its origin in the vegetative sphere, without being in the least mixed up with, or prompted by, any tissue-irritating or spasmodic element.
For reasons given previously it is natural to expect that in the measure as the watery evacuation with its increasing, there will arise nerve-irritation with its subsequent spasms; partly in consequence of the anaemic condition of the blood and partly in consequence of incipient desiccation of nerve tissue. But for all that we should not lose sight of the fact in all such cases, the spasms, muscular as well as arterial are secondary; although they may, in some particular constitutions assume, in the course of the disease, an independent pathological existence of their own known as it is that whenever nerve irritation has once been roused, it may continue even after its primary case had been removed and require as such some special therapeutic measures. In advanced cases. this is always more or less the case, and if the disease has been allowed to go on unchecked till collapse had set in, we know from Dr. Goodeve’s observations, that there is invariably present spasmodic contractions of the pulmonary arteries. A close enquiry as to the way how the disease had developed is necessary before we decide upon the plan of treatment to be adopted.
Characteristic of the diarrhoeic variety of cholera, is its slow, insidious setting in. It begins with a diarrhoea running on for days, or for hours as the case may be, either gradually merging into choleraic evacuations, or unexpectedly bursting forth with a sudden gush of vomiting or purging. There are no cramps, hardly any colic before or during the attack; nor are there indeed, any prominent signs of tissue irritation in the alimentary tract (although there may be a good deal of them, sooner or later afterwards); the whole morbid process being apparently worked out within the silent sphere of the vegetative system. The temperature of the body denotes hardly any change at the outset, unless we apply the thermometer, when a slight fall of a few decimals might be observed. It is in this sort of cases that Ricinus is what Camphor is in the spasmodic variety of cholera; and just as Camphor, or one of its analogues, may be helpful, in fact indispensable, throughout the whole attack, from the first invasion, till collapse has actually set in; so may Ricinus prove helpful and indispensable throughout all the stages of diarrhoeic cholera, the stage of collapse included. You have seen how in the case of poisoning cited before, the Ricinus seeds slowly, almost imperceptibly, worked their way towards the formidable attack the man had to sustain. And then when the attack did manifest itself, there were first a few loose stools, without cramps or even colic; all this came afterwards, in the measure as vomiting and purging progressed just as in diarrhoeic cholera.
In how far the sensation as if a bar laid over his stomach, or the other symptom epigastrium very sensitive; the pains radiate towards the navel and hypochondria may be particularly indicative of the remedy, must for the present be left to future clinical experience.
When I said before that Ricinus may be called for in all the stages of genuine diarrhoeic cholera, the stage of collapse included-I have only to add thereto the condition:provided vomiting or purging, or vomiting and purging still going on; and further provided the remedy just mentioned had not been fairly tried in the preceding stages. If it has been then it would be an act almost bordering on obstinacy, to continue its application, in the face of palpable failure. Nor did I ever mean to say that Ricinus should exclusively be used in diarrhoeic cholera; we should never forger the important role nervous phenomena play in cholera, and how such phenomena may assume a pathological existence of their own, when one brought forth. What I means is this, that we must look in the diarrhoeic variety of cholera so long as evacuations are in a more or less prominent manner present to Ricinus as the leading remedy, and to all the other remedies mentioned before as many auxiliaries; just as Ricinus would have to be considered an auxiliary remedy in all other, but the diarrhoeic variety.
Let us not forget that Ricinus and its analogue-Jatropha Curcas are the only drugs known, that have produced genuine rice- water-like evacuations, whenever the virulence of their irritant action has not been great enough, as to produce gastro-enteritis, with such alvine discharges as are usual under such conditions. Ricinus resembles in this respect Cuprum, which has one action on the gastro-intestinal mucous membrane in large doses, and another one in small doses. With Cuprum, however, the absence of bile, and the rice-water like appearance of the evacuations are exceptional, even where no inflammation is produced; while with Ricinus they are the rule. Again with Cuprum, nervous symptoms, especially colics, precede the loose stools; while in Ricinus the the latter precedes the loose stools, provided the same are choleraic. As to the differentiation between the eventual use of Camphor and Ricinus in choleraic attacks preceded by diarrhoea, I refer you to what I have said on the subject at a previous occasion, when treating at length on the application of the first named drug.
Dr. Behari Lal Bhadhuri, L.M.S Editor of the Indian Homoeopathic Review says:- We ourselves have met in previous practice with two cases brought on by eating the pulp of the seeds. There were rice-water stools, cramps and suppression of urine. We were then followers of the allopathic system, and had to give stimulants to cure the cases. After our conversion to the new school, the facts of the poisoning of these two cases led us to prepare a tincture of the seeds long before we read Hale’s article about the drug. We also supplied it to Dr. Salzer. We expected much from this in cholera cases of our country, but we cannot say that we have given the drug a fair trial. We are in the habit of giving this medicine when Veratrum fails, and in a few cases we have seen undoubted improvement from its use. The fact is, although we knew the provings would give rise to cholera, our faith in the medicine has never been so strong as to enable us to stick to it when improvement was not prompt.
In one of the cases of poisoning related by Dr. Hale there was vomiting and purging; cold, pale, and shrunken skin, and dejections consisting of bloody serum. Stools as above described, sometimes occur at the state of cholera collapse. Mercurius Corrosivus is, generally, the remedy we rely upon, and with good reason, for Taylor in his Medical Jurisprudence says: The symptoms produced by corrosive sublimate, in the first instance, resemble those of cholera; if the persons should survive several days, they in some respects assume the character of dysentery. We do not make use of Mercurius Cor. in cholera cases, because of its prominent inflammatory action on the bowels which is never present in cholera; but when the discharge from the rectum becomes bloody, it is the best remedy at our disposal. Theoretically speaking, we should have in Ricinus a rival in this respect to the drug before mentioned, although I can say nothing as far as experience goes. Mercurius Corros. appears to be indicated when the above described stools are attended with tenesmus, while Ricinus should act under similar circumstances better, when there is no tenesmus. In how far Mercurius Corrosivus should supersede all other cholera remedies, in patients tainted by syphilis, is as yet an open question with me. Not a single one of our cholera remedies corresponds to what Hahnemann called psoric constitution, and what the late Dr. V. Grauvogl showed to be identical with what he designated as the carbo-nitrogenoid constitution, that is to say, a constitution, in which oxydation is deficient, not in consequence of some local derangement of the organs of respiration and circulation, but in consequence of the blood corpuscles having partly lost their functional capacity of carrying oxygen. Mercury has the same effect upon the blood, and is in fact as homoeopathic to the psoric or scrofulous, as to the syphilitic constitution. I need not tell you that in the advanced stage of cholera, if not from the very beginning, a somewhat similar haematic condition prevails. Who knows how many lives could have been saved by a judicious administration of Mercurius Corros., had we not been such inveterate routinists in all matters concerning the homoeopathic treatment of cholera? We do not reject Arsenic because of its decided inflammatory action on the gastro-enteric mucous membrane; and there is no earthly reason why we should not try at least in some such suitable contingencies, as hinted at, what the corrosive sublimate can do. The 3rd centesimal should be the lowest attenuation employed.
