In the morning he was somewhat better. I was again called to see him in the evening. There were some collection of wind in the bowels, was restless, stools yellow, but not altogether watery. Now and then sighing respiration. He talked with great difficulty and said he felt exhausted on speaking. Gave Natrum Sulph. 12th. There was some improvement in the morning. In the evening the symptoms again aggravated;began to pass-yellow liquid stools and become very weak and prostrated. I gave China 6th. This at once produced the required improvement and he passed the night well. He had good sleep and the stools had become almost normal. His prostration also was not so marked.
A child, 9 years old, got cholera at the latter part of the night of the 25th. In the morning he was seen by the family physician who suspected worms and gave Sulphur. He was passing watery stools, and would vomit water immediately he drank it. Another practitioner saw him and gave Ricinus 6th. He was not able to retain even a teaspoonful of medicine before that; the medicine now enabled him to retain water till a large quantity of it collected. One dose of Ipecac. 30 made him all right.
Without attempting to enter into a speculative contemplation about what might after all be a mere coincidence, I shall content myself to state the fact, that both cholera and the Ricinus plant are indigenous to India, and especially to Bengal.
A chapter on the treatment of diarrhoeic cholera would be incomplete without mention of the premonitory diarrhoea and its treatment. This is of so much the more importance, as the character of the cholera-preceding diarrhoea will often determine the choice of the remedy to be administered during the actual cholera attack.
Not every case of diarrhoea occurring during a cholera epidemic is necessarily a fore-runner of cholera. On the other hand, every such case may, when unchecked, run on, gradually or suddenly, to cholera. This merging of the one into the other, manifests itself either by the character of the stools, or by the fact that the urinary secretion grows less and less. A diarrhoea during a cholera season accompanied by deficient micturition should, under all circumstances, be looked upon as incipient cholera, and treated as such. To check a diarrhoea during the prevalence of cholera, may therefore mean very little or very much. It will be our task to pay the utmost attention to all bowel disorders at a time when cholera is prevalent.
Remember, please, that a cholera case preceded by diarrhoea is not necessarily of the diarrhoeic variety.
It is hardly possible for me to enumerate here all remedies that may be called for in the disorder under discussion. The following are a few of the chief remedies:-
Aconite. Pulse accelerated, soft; sensation of cold intermingled with heat; after exposure to great heat, or after perspiration had been checked by a chill; after fright, fear, or other depressing influences: skin dry; thirst; stools bilious or white; urine high coloured; sensitiveness to cold, likes to be covered; prevalence of paralytic cholera.
Asarum Europ. Habitually chilly, nervous, weakly; mucous or watery stools.
The indications for Arsenic have already been mentioned before.(*See page 126*) —————————————————————– Camphor. Diarrhoea sudden, brought on by a chill; chilly sensation not intermingled with a feeling of heat; sweat, if there be any, rather cold, clammy; no desire to be covered; pulse wiry, number of pulsations normal; no thirst; stools faecal, dark brown; prevalence of spasmodic cholera.
China. Diarrhoea occurring in hot weather after eating fruits. The stools is lienteric; yellow, or brown, watery, offensive. Worse at night or after eating.
Croton Tiglium. Evacuation sudden, copious, watery, yellowish green, coming out with a rush; patient is moved after every drink; prevalence of diarrhoeic cholera.
Hydrocyanic Acid. Pulse weak, quick, variable; oppression of the chest; unpleasant sensation of the epigastrium; weakness in the limbs-all coming quite suddenly. Stool almost involuntary.
Ipecacuanha. Nausea may be a concomitant symptom in all cases, where the remedies mentioned before, or to be mentioned hereafter, are indicated; wherever this symptom is prominent and constant, it may be considered as an indication of Ipecac. Stools fermented, green.
Oleum Ricini. 1 to 3x. Whenever there is no distinct indication for any particular remedy, I would advise a trial of the Oil of Ricinus; especially during the prevalence of diarrhoeic cholera.
Phosphoric Acid. Evacuations ash-grey colored, liquid, copious, painless; tongue covered with a gluey-mucus; general sense of weakness, not felt to be caused or increased by the evacuations.
Sulphur. Diarrhoea coming on suddenly after mid-night, awaking the patient and driving him out of bed. (Such cases of diarrhoea frequently give rise, when unchecked, to the worst types of cholera). After midnight diarrhoea may also point to Pulsatilla, when caused by a diet of pastry, pork, fatty meals in general or by eating ice-cream after a meal. Stools greenish, yellow and slimy; stools continually changing character: now yellow, now green, now watery, now slimy and frothy.
Periodicity plays a great role in the life of men; and thus it becomes an important factor in disease, and consequently in all processes of restoration to health, whether such processes be brought about by Nature’s innate recuperative power, or by some outward impulse in the shape of drug action. It is well known that, there is a slight diurnal variation in the temperature of the body, quite irrespective of external heat or cold. The minimum temperature occurs, according to Dr. Jurgensen, from 1-30 A.M. to 7-30. Sidney Ringer and P. Stewart found the period of highest temperature to extend from 9 A.M. till 6 P.M.; the lowest in about midnight. These observations fully correspond with what is otherwise known with regard to the relative activity of the respiration and circulation at different periods of the twenty- four hours. The occurrence of a sudden diarrhoea during the prevalence of cholera, after the midnight hours, is therefore more than a mere incidence. The Sulphur diarrhoea is characterised by a similar peculiarity, and has done us good service whenever indicated. Sulphur should not be repeated too often, nor should it be administered in too low attenuations. Even after cholera has already made its appearance, and the usual remedies fail to do good, we shall often derive a good deal of benefit from the administration of a dose of Sulphur to our patient, provided the premonitory Diarrhoea had set in the peculiar way.
Now and then we find in allopathic journals a case, or a whole series of cholera cases, reported, as having been cured by Sulphurous Acid. Then the drug is put to the test by some others, and found to be of no use. The Old School of Medicine has yet to learn, that there is no specific for any disease as such, although the chase after such remedies has now gone on for thousands of years. A general pathological disorder experiences some modification in its manifestations in each given subject; this modification is due to the constitutional variety of the subjects affected–to their respective individuality; and whenever we neglect, in our therapeutic attempt, to take notice of this individuality, we shall find, that we have reckoned without the host.
While preparing these lectures, I tried Sulphurous Acid on myself, and I thought I should be able to lay before you a whole array of symptoms. I gave also about two drachms of it to an Indian employee of the firm of Messrs. Berigny & Co., a man whom I always found reliable and trustworthy; neither he nor I could develop any symptoms. I went so far as to acidulate my drinking water for two days with the drug mentioned but to no effect. It set my teeth on edge, and I gave it up in despair. For all that, I am not prepared to say, that Sulphurous Acid is an innocuous drug. Its toxic action most likely begins after large doses have been taken for a considerable long time.
Sulphur has some reputation as a cholera prophylactic. Dr. Hering says : Sulphur prevents Cholera Asiatica with individuals, if the finest powder, called milk of sulphur, is put into the stocking, so as to come in contact with the soles of the feet; a pinch a day is sufficient to cause a gentle pouring out of sulphurated hydrogen through the pores of the skin all over the body, blackening bright silver. But whether the substance which carries the disease is destroyed by it, has not been ascertained yet. Prophylactics should be selected not only according to the requirements of the genus epidemicus, but also, and in certain cases I should say chiefly, according to the requirements of the individual they are calculated to benefit. Patients afflicted with skin diseases, with piles, with congestions of head, lungs, etc., might benefit more from Sulphur than Cuprum. Cuprum Sulph. should, anyhow in the case of some individuals, be preferred to Cuprum Met., and this not only as a prophylactic, but also as a remedy, should they be attacked with cholera.
