I have to-day to entertain you, gentleman, about a third variety of cholera, of which I have hitherto kept silent, in order not to complicate the subject which has all along occupied our attention. This variety will form the subject of my present lecture.
Although, however, I have not distinctly made mention of the cholera variety which is intended to occupy us this day, I have clearly pointed as at on a previous occasion. When speaking of the diagnostic differentiation between the spasmodic and non- spasmodic variety of cholera I said :
Concerning the state of the patient at the time when we are called upon to decide the special nature of his disorder, we may say : Whenever cyanosis and objective coldness of the body sets in at the commencement of the disease, it may be considered almost a sure sign, that we have before us a case of cholera attended with arterial spasms. When the choleraic discharges are idiopathic, cyanosis and objective coldness increase with the frequency of the evacuations, and unless the same be very profuse from the very beginning, it takes a few hours, as a rule, before anything like cyanosis and sensation of coldness to the touch are prominently established. Their comparatively early manifestation show that the venosity of the blood to which they are due, is not a consequence of the vitiated condition of the blood, but of the spasmodic arterial obstruction. In such cases the dyspnoea will also be found greater at the very beginning, than it would be the cases, whenever the choleraic evacuations are at the root of the disorder. You will also find the thermometer in keeping with the general state of venosity, and consequently lower, than in the non-spasmodic variety of the disease. In short, a state of depression, coldness, dyspnoea and cyanosis, out of proportion to the choleraic evacuations just set on, denote the origin of arterial spasms. The pulse will be a further indication to you, for with the arterial spasms there is arterial tension; the heart corresponding with the general state of the vascular system, will be found to be in a state of irritation, its sounds more or less accentuated; while in the non-spasmodic variety the pulse is soft and more or less compressible from the beginning, and the impulse of the heart is weakened. Corresponding with this state of things we find such patients listless, apathetic, indifferent towards all their surroundings; while the choleraic patient of the spasmodic variety is restless, full of anxiety–not so much anxious perhaps about his condition, as about the want of air, he cannot help feeling.
Let us, however, not forget that all the above mentioned symptoms–dyspnoea, algidity and cyanosis–may just as well originate in a state of cardiac paresis, though the sympathetic system in general may not be particularly disordered. In fact, as far as the circulation is concerned, the consequences of a weak action of the heart are just the same, as what follows spasmodic contraction of the muscular coat of the arteries. In the first case there is deficiency of propelling power; in the second, there is increase of resistance to the flow of blood through the vessels: the effect, it is evident, must be in both cases, well- nigh the same–impeded circulation and venous congestion, or incomplete aeration and oxydation of the blood, hence dyspnoea, algidity, and lividity, and as a secondary consequence, congestion of the portal system, diarrhoea, and-under the influence of epidemic cholera–rice-water discharges. We shall see hereafter that such a combination and sequence of symptoms may occur during a cholera epidemic. Yet Camphor, which is nothing if not spasmodic would be out of place in such a contingency, where paresis of the heart’s action is, if not at the root of all the evil, at any rate, prominently associated with the danger attending the existing evil. If you want, therefore, to make it sure that the dyspnoea and cyanosis, eventually present at the very onset of cholera, are really due to a spasmodic condition of the arteries; in other words, if you want to make it sure, that Camphor, or one of the drugs analogous to it in action, is beyond any further doubt, the homoeopathically indicated remedy in the case before you, then you will have to take the state of the patient’s heart into consideration, before coming to a definite conclusion on the subject.
You see then, gentlemen, that the non-spasmodic variety of cholera is not restricted to the diarrhoeic variety; that there is, moreover, a variety of cholera possible, with all its virulent signs of cyanosis and algidity from the very onset, without being associated with general, arterial spasms, but with a state of things, rather opposite to spasms; in other words, with a state marked by paresis, either of the heart alone, or conjointly with a paralytic state of the vaso-motor nerves in general.
That this is no imaginary cholera variety we have only to consult various authors, who describe a variety of what they call Cholera Acuta. The patient feels as if he were stunned; or he has a sensation of a load on, or of weight in his head. This is associated with vertigo, vanishing of sight and hearing, numbness with or without tingling in the extremities; oppression of the chest; pulse rapid and feeble; soon after, nausea, retching, or vomiting, rumbling in the bowels, with or without gripes; watery motions; suppression of urine, and so on. Dr. Buchner called this variety-Cholera Paralytica, and this is certainly a more appropriate name, considering that it expresses the fundamental pathological condition upon which the disorder depends.
Like the spasmodic variety, the paralytic variety of cholera may either constitute in itself a life-endangering disorder, owing to threatening or actual failure of the heart’s action; or it may supervene to diarrhoeic cholera, in any of its stages, and assume an independent pathological existence, requiring therapeutic measures especially adapted to its condition.
As already indicated before, these two phases of acute collapse–the spasmodic and the paralytic–can only be distinguished from each other, by a close examination of the cardiac action. I am afraid, sight has altogether been lost of this important distinction in our school, and Camphor has often been administered where there was algidity and cyanosis without spasms, which, taken by itself, irrespective of the condition of the heart, may mean in many cases an invasion of Cholera Paralytica and not of Cholera Spasmodica.
Let it be remembered that, although the two varieties mentioned before, seem to be in every respect opposite to each other, they nevertheless likely to merge into each other. It is especially the spasmodic variety which is liable to end in a state of cardiac and vasomotor paralysis, known as it is that excessive and continual nerve or muscular irritation ultimately results in exhaustion. On the other hand it is a well established fact, that whenever a muscle is deprived of its due supply of oxygen, so that the blood circulating within its tissue becomes venous, the venous blood stimulates for a time the muscle to contract. Venosity with its vaso-motor paralysis may thus give rise to spasms of all sorts. Again diarrhoeic cholera may become complicated, either with spasmodic or paralytic cholera, and it may at one stage assume the form of the one, and at the next stage the form of the other. Much will, therefore, be left to the ingenuity and discrimination of the practitioner, in the treatment of a disease of so complicated a nature as cholera.
After this preliminary observation which will now be far better appreciated than it could have been at the beginning of these lectures, I shall lay before you those drugs which are, from a homoeopathic point of view, best calculated to meet the cholera variety under discussion.
Foremost amongst them stands Veratrum Album. The pathogenesis of this drug resembles in a striking manner the paralytic variety of cholera. The stools are not choleraic in Veratrum poisoning; they are distinctly bilious in their character: greenish, watery, with flakes. The secretion of urine is by no means suppressed under its toxic influence. Barring, however, these two most important disqualifications, the drug just mentioned presents a pathogenesis, strikingly similar to paralytic cholera. As it is, it would represent an exact picture of choleraic diarrhoea, or cholerine. Yet many remedy we have discussed in previous lectures, that has been found wanting, as far as its pathogenesis went, in some cholera essentials, has nevertheless yielded very essential therapeutic results in the clinical experience of our school. We have seen what Camphor can do, in arresting the progress of spasmodic cholera, if not as a remedial, yet as a palliative agent; although this drug is well known, not to have anything like choleraic evacuations amongst its pathogenesis. By virtue of its antispasmodic action on the arterial blood-vessels, it relieves the portal system of its congestion, and arrests the transudation of serum kept up by that congestion. A similar congestion may be brought on by vaso-motor 0………paralysis, and Veratrum may, and does, act beneficially in a similar manner, apart from all its direct influence upon the intestinal mucous membrane. The following cases of poisoning are intended to show, the sphere and mode of action of the drug under our present consideration:
