In seasons where dysentery and cholera are simultaneously prevalent-and in tropical climates such a concurrence is by far not out of the range of possibility – we should again look to Ricinus as the remedy particularly indicated by the genus epidemicus. Again in such cholera cases which happen to be preceded by a diarrhoea consisting of bloody serum, we shall have one reliable indication more for the application of the drug so often mentioned. Gambogia should be remembered in cholera, and particularly in choleraic diarrhoea when the frequency of the stools goes hand in hand with the frequency of drinking water. The Gambogia stools are yellow, watery; but even choleraic stools proper might be benefited by the occasional administration of a dose of Gambogia in such cases.
In connexion with Ricinus I mentioned before, as one of its analogues, Jatropha Curcas; and I might have mentioned another drug besides namely, Euphorbia Corollata. I must however confess, I have never used the latter mentioned drug in cholera nor have I ever heard that somebody else had used it with anything like success. Both these drugs are so far analogous to Ricinus, that they produce in the healthy, rice-water like dejections from the stomach. The stools are watery and painless, but not rice-water like, at least as far we are able to judge from the records before us, regarding provings and cases of poisoning. To be however fair and impartial in our comparisons of drugs with respect to the eventual similarity of their physiological effects to cholera, we should not lose sight of the fact, that as far as our records of provings with or of cases of poisoning by, Ricinus is concerned, we miss in a similar manner a distinct statement to the effect, that the vomit produced under the influence of the last mentioned drug had even been rice-water like. However, we have under the head of Ricinus the following symptoms, which come pretty near to cholera vomit: The vomited matter is fluid, lightly colored by some bile; and holds some glairy filaments suspended. And again: Violent vomiting and purging, accompanied by burning pain in the gullet and stomach with all the symptoms of Asiatic cholera (Allen from Pharm. Journ. 1866, Effects of eating a few Seeds)
But were even the vomit caused by Ricinus as deficient in similarity to that occurring in cholera patients, as the alvine evacuations of Jatropha and Euphorbia respectively appear to be, we should still feel justified in considering the toxic action of the first named drug by far more homoeopathic to the disease under discussion, than the action of either Jatropha or Euphorbia. The very name of diarrhoeic cholera tells you the history of this variety of cholera, to which variety alone the aforesaid drugs can after all lay a claim as to their eventual homoeopathicity to cholera. It is then the intestinal mucous membrane which, in that variety, gives out the first sign of distress; we know besides from clinical experience that purging in some shape or other often continues long after vomiting has ceased: reason enough why we should give preference to Ricinus, even if it were deficient in homoeopathicity with respect to the nature of the fluid matter brought up by the stomach.
With regard to suppression of urine, so significant a symptom in cholera, Ricinus is again homoeopathic as we have seen from the before-cited case, while Jatropha and Euphorbia are not. There is one symptom more worth mentioning concerning Ricinus- it is recorded by Allen from the Journal de Chimie Medical, 1856. In a man who ate the seeds of Ricinus gangrene appeared in one foot and necessitated amputation. How important this symptom may be for us, should a future experience teach, that it is a genuine toxic effect of the drug may be apparent to you, from what I have said in a previous lecture about Secale Cornutum.
Jaundice is not a frequent sequel of cholera; we have however seen, that it is so, in choleraic fever, here again Ricinus may be of great therapeutic value to us. Ricinus produces jaundice.
To give you the full pathogenesis of Jatropha, would simply be to repeat, as far as vomiting purging and spasms are concerned, the pathogenesis of Ricinus, with such differentiations as I have pointed out, as peculiar to the last mentioned drug. Remembering besides that the three plants Ricinus Communis, Jatropha Curcas and Euphorbia belong to the same family of Euphorbiaceae, we shall by no means be surprised, that their respective physiological action does not differ much from each other. There is, however, nod death recorded in consequence of Jatropha-poisoning although amongst the records, there is one of a sailor who ate a handful of the seeds. With Ricinus, we have seen it is otherwise. Jatropha seems further to have some direct effect upon the heart, depressing its action and causing some palpitation. Nausea is one of its prominent effects, and the vomiting seems in most cases of poisoning at least, to have preceded the purging. On the whole it would appear that Jatropha exerts its toxic action, primarily, on the pneumo-gastric nerve. Of Jatropha Urens we read in Allen the following, rather puzzling remarks. Jatropha Urens (the most poisonous plant known) Natural order: Euphorbiaceae. Authority: kew Garden’s Quarterly Review, December, 1851. Mr. Smith in reaching over the plant touched his wrist against the fine bristly strings. Numbness and swelling of the lips. The action of the poison was on the heart circulation was stopped, and Mr. Smith soon fell unconscious; the last thing he remembered being cries of `Run for the Doctor’. It would not be wise at the present state of our knowledge about the cardiac action of jatropha Urens, to trust to it in collapse, when paralysis of the heart is threatening. Should however such a state be associated with persistent nausea, the drug might deserve a trial.
Since the first invasion of the Jatropha poison makes itself felt by nausea and vomiting, and since the vomiting, caused by it is described as easy and copious, consisting of a large amount of a watery albuminous substance we might give the preference to Jatropha in all such similar cases occurring in cholera, the stools being either simultaneous with the vomiting or following it. Concerning Euphorbia we notice on the other hand the following: Suddenly with no premonitory symptoms of pain, a distressing sense of deathly nausea sets in, accompanied in a few minutes by faintness; then sudden and powerful vomiting of, first the food, etc. in the stomach, then large quantities of water mixed with mucus, then clear fluid, like rice water. This last symptom is italicised by Allen, and marked by an asterisk which means that the symptom has been verified by clinical experience. In continuation of the above symptom we further read: In less than a minute after the vomiting commenced, great commotion in the bowels, followed immediately by copious watery evacuations; this simultaneous vomiting and diarrhoea continued for nearly an hour, at short intervals or intermissions, all the while accompanied by great anxiety, a death-like sense of faintness and exhaustion. This was the effect of 25 grains of the powdered root. After 50 grains the effects were much more intense, but lasted only a little longer. Languor, great weakness, prostration were common to all the three provers. One prover had cold head, feet and nose, and cool skin all over. There were no pain, neither spasms noticed by any of the provers. Jatropha on the other hand has sharp colic in the transverse colon and rumbling in the abdomen-reported by one prover; others report of more or less severe colic; others again were free from colic, but complained of much noise and rumbling in the abdomen; or constant gurgling as of liquids, low down in the abdomen; with rumbling of air. Again, with regard to spasms, Jatropha has produced spasms of the extremities by far severer than those occurring under the influence of Ricinus; it is especially the calves where the Jatropha spasms make themselves the most felt. Painless diarrhoea seems to be common to all the three drugs under discussion. Under the influence of Jatropha. we read, as a prominent and often clinically verified symptoms Watery diarrhoea, as if it spurted from him.But though the dejections from mouth and stomach seem almost to be characterised by their profuseness, yet the Jatropha subject has none of the signs pointing to any serious disorder. His skin is neither cold all over, nor cyanotic; neither shriveled nor bedewed with cold sweat. Eyes not sunken; nose not cold, neither pointed; face by no means distorted, hardly pale; voice neither feeble nor husky. There is no feeling of anxiety; one prover actually reports: An ecstasy, as if an ideal had appeared to a poetic painter, or like that which sometimes comes to a dying person, with bright eyes directed upwards, a feeling of lovely warmth and ethereal lightness, during the painful diarrhoeas. From all this we see, that purging and vomiting even of a rice-water-like fluid does not yet constitute cholera. Jatropha and Euphorbia may be excellent remedies in choleraic diarrhoea; in diarrhoeic cholera they could hardly be expected to be of more than symptomatic significance in the treatment of the disease. It would not be wise to trust to either of them in the advanced stage of cholera; but at its very outset, they may do much good by checking the threatening invasion. Strange to say, it is just as to the mode how the attack sets in, that the differentiation between their physiological action is most marked. Thus :
