CASE XII.
Mrs. G., October 22.-The mother of this patient died of cholera. We found this woman, her brother, a lad of 17 years old, and two children, lying on a miserable shake-down on the floor. She vomited this afternoon, m but felt quite well when she went to bed. About half past eleven she was seized with sickness and purging, dejections coming from her in a watery stream. There was much pain in the back, and dry retching. She had made water about half an hour, before. Surface of body warm; hands and face cold and clammy; tongue cold, breath warm; pulse indistinct; great anxiety-often begged us not to leave her; cramps in the legs. Was seen at 12 P.M.
Camphor a dose every ten minutes.
15th. Half-past twelve A.M.-pulse more easily felt; dry retching, much thirst. Quarter to one-Cramps returning more severely; purging more urgent; great thirst. Temperature of the body as before.
Arsenic and Veratrum in alteration. And so on.
From the etiology of the case we know that it was one of the non-spasmodic variety. The case was seen at the stage of development, and Camphor, for reasons stated before, could not and did not arrest the progress of the choleraic evacuations.
CASE XIX.
J.H., aged 38.-Intemperate habit. He was drinking to excess yesterday. Was seized at ten last night; watery vomiting and bowel complaint. We saw him first at half-past seven A.M., 13th November. Watery purging through the night; urinated about an hour ago; severe cramps in the legs, arms, hands and sides; body warm, feet, hands and face cold and livid; pulse 106 small, weak and indistinct; voice hoarse; great thirst.
Tincture Camphor every five minutes.
10 A.M., cramps in legs very severe; in other respects the same.
Veratrum and Cuprum in alteration, and so on.
For reasons given before, this was not a case calling for Camphor. This was a genuine case of diarrhoeic cholera, body was warm; no collapse as yet. Treatment was then intended to arrest the vomiting and purging. Camphor has failed, and we know why;- it was never indicated.
CASE LXI.
E.B., a woman, aged thirty-three. Her child died of cholera yesterday morning. Was quite well last night when she went to bed. At 3 this morning, 10th December, she was seized with bowel complaint; faeces ran from her before she could rise, has since purged every fifteen to twenty minutes, stools reported at first natural in appearance, later of clear water; vomiting commenced at the same time; cramps about an hour afterwards; vomited during the visit clear water, which ran from her without much retching in a continuous stream; complained of pain in the side; much cramp in the calves of the legs; no urine since last night; pulseless; respiration eighteen per minute; had taken Camphor since 4 A.M. every ten minutes without improvement.
No wonder, after all we know about the case on the one hand, and about Camphor on the other.
One remark more before I am going to close the chapter of Camphor. You have heard how Hahnemann wished us to prepare the Camphor tincture; and from the extract of Dr. Hoyne’s Clinical Therapeutics you have learnt how Dr. Rubini prepared his tincture, known by the name of Rubini’s Camphor. I believe, however, both of these methods of preparation have their faults. Administering as we do the tincture in substantial doses, say five drops every 5 to 10 minutes, it comes to this, that a man after having continued for two or three hours the administration of Camphor, has swallowed at the same time two or three drachms of an alcohol only a few degrees less than absolute. Such two or three drachms if reduced to the strength of a drinkable spirit, would give a liquor nearly equal to one ounce of brandy. Now this is a medicinal dose of brandy, for people not accustomed to spirituous drinks. While we talk about administering to them Camphor, it is in reality Camphor plus alcohol that we are administering to them. Worse than this that the alcohol must necessarily vitiate more or less the pure action of the drug, known as it is that both alcohol and Camphor exercise a powerful action on the vaso-motor nervous system; and that these respective actions are in direction opposite to each other. I would, therefore, proposed that we should use a Camphor trituration in preference to a tincture. It might be objected that a trituration would soon be dejected by a cholera patient, while a tincture. It might be objected that a trituration would soon be dejected by a cholera patient, while a tincture may still find its way within the organism by means of imbibition. This should, however, not deter us from a trial; as far as I have tried it, I may say, it acts satisfactorily though not so rapidly, and although my experience with it is not sufficiently large. it is still large enough as to entitle me to say without hesitation, that it should certainly not be left untried, wherever the drug is undoubtedly indicated. The best way I should say, to begin with the tincture, and as soon as the first signs of improvement show themselves to substitute trituration instead.
In how far the physical properties of Camphor may account for its therapeutic action in cholera, I am not prepared to say. It is, however, worth mentioning, that Prevost, according to the statement of Dr. Carpenter, has shown, that a thin layer of water, extended on a perfectly clean glass plate, retracts when such an odorous substance as Camphor is placed upon it.
As to the dose, I may state here, that five drops of Rubini’s solution of Camphor contain about 2 grains of Camphor. If we triturate our Camphor in the proportion of 1 to 5 of sugar of milk, then each 5 grains of such a trituration would contain 1 grain of Camphor; ten grains should then be the dose required. Experience teaches moreover that by far smaller doses are sufficient when Camphor is administered pure, that is to say in form of trituration. Thus two grains of a 1-5 trituration. Every 5-10 minutes will be found a sufficient dose in all cases of emergency. Camphor is but slightly soluble in water, but when mixed with sugar, it becomes almost completely soluble. The trituration can, therefore, be administered either dry on the tongue, or in a wine glass of water.
Inconvenient results, says Dr. Carrol Dunham, have sometimes been observed from the use of too large and too frequent doses of Camphor; and the public should be cautioned against using Camphor without a clear indication of its necessity. Where too much has been taken, it produces terrible anguish and burning at the pit of the stomach, so great as to drive the sufferer almost to despair. A few globules of Phosphorus will promptly antidote the Camphor and relieve the patient.
