CASE XXVIII.
C.P., a woman, aged 27. Her father had been ill of cholera and she had attended him for the last two days; during that time she had taken scarcely any food, and had had no rest. While sitting at the fire side last night, about 10 o’clock she fainted, and was put to bed. She felt cold and had some brandy and water; after that she shook and her teeth chattered. Vomiting began about 11 P.M. She had cramps, severe pain in epigastrium, and pains over the whole body, which made her cry out and restless. She was first seen at half-past two A.M., November 21. She was roaring from cramps all over the body which made her wretched. Eyes wide open, expressions restless; complained of coldness in her bowels; face, lips and hands cold and pale; tongue warm, pulse 104, unsteady.
Tincture Camphor every quarter of an hour.
9.A.M.-Fell asleep after taking medicine; slept till 8. A.M. 100; no vomiting, no purging; great general pain; no urine passed.
Continue Camphor.-
22nd November 9 A.M.-Was up, sitting by the fire.
This looked like a Cuprum case. But the attack was ushered in by a feeling of cold; and Camphor is, so to say, our cholera Aconite. Whenever the vaso-motor nervous system is the first or the chief sufferer, there Camphor will be found to be the first and chief remedy.
CASE XXXV.
I.R., aged 4.-Was quite well to-day, 11. Dec. While sitting playing, about 3 P.M. she cried out suddenly on account of pain in her bowels, and when relieving them began to vomit white frothy fluid. She became stiff, cold and blue, particularly below the eyes; complained of pain in her belly and fainted; no urine since forenoon. Seen at 9 P.M. and ordered
Camphor half-hourly.
12th, 9 A.M.-After a few doses of Camphor went to sleep; slept well and perspired; urinated this morning. Was playing and seemed well.
Cramps, coldness and cyanosis set in early, and were out of proportion to the choleraic discharges; this was a spasmodic variety of cholera, although it apparently began with bowel complaints.
CASE XXXVII.
J.T., aged eleven.-Had been purging and vomiting occasionally since Sunday last. Became much worse yesterday afternoon, 3rd January. First visited 4th January, 4 A.M. Had watery purging and vomiting; skin cold, hands blue, tongue icy cold; quite pulseless; looked dejected; great thirst; said he had no pain.
Camphor every 10 minutes.
11 A.M.- Two stools; no vomiting, skin and tongue warm; urinated this morning.
It is easy, strictly to follow a certain plan in the course of a lecture; but when it comes to clinical demonstration, then it is not to be expected that your patient will be willing to keep, for the sake of your arrangement, within certain limits. The history of the patient before us shows, that we have to deal with the non-spasmodic variety of cholera, in other words with diarrhoeic cholera, and that the case has passed the stage of development; it is a case of cholera collapse, and in so far, not a fair subject for the present lecture, which deals only with the first stage of cholera, endeavouring to teach how to arrest its further progress. Here the mischief has already been done, and the question is how to minimise its effect, and how to save life, if possible. You will remember from what I have said in a previous lecture, that this mischief is partly haematic-loss of the watery portion of the blood and partly neurotic-irritation of the vaso-motor nerves in consequence of desiccation, and spasmodic contraction of the pulmonary and general arteries. We see then how the non-spasmodic variety of cholera ultimately leads to a state of things, similar to the spasmodic variety. Of course the conditions are by far worse in the stage of collapse than they ever can be at the first stage of spasmodic cholera; owing to the improverished state of the blood which in itself constitutes a serious danger. But there is hardly anything to be done in the shape of medicine for the improvement. of the blood. The blood requires water for its restoration and for the purpose of its free circulation within the blood vessels. It is therefore only the latter, in so far as they are spasmodically contracted, that we can reach by appropriate medicines. And you see here again Camphor to have proved itself to be the proper medicine. In fact all the remedies which are homoeopathically indicated in the first stage of the spasmodic variety of cholera, are on the same ground called for at the stage of collapse; knowing as we do, that cholera invariably closes with spasmodic contraction of the pulmonary arteries. Here is another case to the point.
XXXIX.
Mr. K., aged twenty-six-Had nausea and vomiting during the night, with cramps in the abdomen and pain in the epigastrium. Seized at 5 P.M., 9th January; seen first 10 A.M. Vomiting of large quantities of whitish watery matter; purged once very profusely; pain in abdomen and epigastrium; shaking and chattering his teeth; great thirst; breath cool; pulse quick and weak; skin cold; no urine since early in the morning.
Camphor every quarter of an hour.
3. P.M.-Still sick; vomited twice, but free from pain; pulse fuller and regular.
Ipecacuanha, hourly, and patient, after taking besides some Nux Vomica, made a good recovery.
CASE XLI
Mrs. S., Aged 43, was suddenly seized at four this afternoon, 15th January. First seen at 5 P.M. Watery purging and vomiting; cramps in the epigastrium; great thirst; no pulse perceptible; extremities cold; face haggard; eyes sunk; suppression of urine.
Camphor every ten minutes.
8 P.M.-Better; pulse 100; passed urine; stools fewer and more faeculent. Mercurius and Nux completed the cure.
The pulselessness at so early a stage of vomiting and purging; justified the choice of Camphor, although the choleraic evacuation had been already fully established. When I took occasion lately to write, saying that the more virulent the choleraic attack, the more exclusively must we look, at the beginning of the attack, to Camphor for help I was contradicted; I was told, that this does not at least hold good in all epidemics. Of course not; not even in all cases of the same epidemic. Nor did I ever mean to establish a general rule, where individualisation should be the main guide of our action. In cases calling by their pathological and symptomatical indications for Camphor, I repeat, the more virulent the attack, the more exclusively must we look to Camphor (or to Hydrocyanic Acid?) for help. When arterial spasms are great at the very onset of the disease; when cyanosis and algidity are so considerable at the very beginning, as almost to threaten life; then let us not run away from Camphor after half an hour’s trial. Neither Cuprum nor Veratrum will make things better; Hydrocyanic Acid might. Of that drug, however, so unreasonably neglected in our school at the onset of a cholera attack of the spasmodic variety, hereafter. But it is certainly not the virulence of the disease, per se which should determine our choice of a remedy, or our persevering with it when once selected. It is the nature of the case, the condition of the patient, which must determine our mode of action. I should not advise for one moment to persevere with Camphor, if the virulence of the attack consist in profuse choleraic evacuations, rapidly exhausting the patient, by impoverishing his blood and desiccating his tissues. Camphor should not even be tried in such cases, virulent as they may be.
I have said the early pulselessness justified the choice of Camphor. You have heard that this symptom may originate in two different conditions; either in spasmodic contraction of the muscular cost of the pulmonary arteries, and more or less of the arterial system in general-or in failure of the heart’s action. In the latter case, Tartar Emetic or Veratrum Album would be the homoeopathic remedy, as we shall see hereafter. The stethoscope could tell us which is the real state of the case. In the case before us, we are left in the dark about the true nature of the condition.
I wish I could go on giving you only successful cases of Camphor treatment; my aim is, however, to illustrate its action as well as its inaction in cholera.
The following are a few of the cases that ended fatally:-
CASE VIII.
Mrs. M., aged 45, had been in good health till last night, when she was affected with diarrhoea; at 6 o’clock of the 29th October, she was attacked with watery vomiting and purging and cramps in the limbs. She was first seen at half-past eleven A.M. of the same day, and we found her face sunken, her hands and nails blue and shriveled; the pulse could not be felt; the voice was barely audible; the tongue and breath were quite cold.
Camphor every five minutes.
Half-past one- No better. And so on.
This is again a diarrhoeic cholera case in the state of collapse; Camphor did not help, and is a doubtful if any other remedy would have done better. If we remember that, according to Dr. Macnamarra’s statistical observations, only ten per cent. of patients in the stage of cholera recover by themselves, then we must not lose heart and confidence at the eventual loss of such patients.
