All this is most useful information to us. The Veratrum spasms have nothing in common with such as are liable to occur under the action of Cuprum, which latter are reflex, starting from gastro-intestinal irritation, and assuming later on a more or less independent character of their own, after the irritation has spread to the motor centres. Nor are they like the Ergotine spasms, which as we all know, are cerebro-spinal, although it is still doubtful if the drug exerts a directly irritating action on the brain and cord, or if the irritation is due to an anaemic state of those organs, consequent upon arterial contraction. Neither are they like the Camphor, the Arsenic or the Hydrocyanic Acid spasms, which take their origin in the medulla oblongata, and are asphyctic in their nature. The Veratrum spasms are due to direct irritation of the muscular substance, that is to say, of the muscular protoplasm, while the muscular function is all along tending towards temporary extinction. The whole feature of a Veratrum victim denotes a state of utter prostration and helplessness. Owing to cardiac and vaso-motor paralysis, the circulation of the blood in the lungs is almost suspended; there is want of breath, but hardly any respiratory, struggle-no clonic convulsions-for the respiratory muscles are paralyzed; what there remains of muscular excitement is simply of the nature of local irritation, giving rise to tetanic contraction.
If we now ask Where do we find a counter part to the above picture? Then I say, in patients in a state of acute collapse, after fatigue brought on by physical work, long walks, etc., and exposure to extreme heat. In such men, muscular function is more or less exhausted, while the nutritive function of muscular tissue repair is so much the more active. Here we have a fair counterpart of what is going on in a Veratrum subject– protoplasmic irritation coupled with functional exhaustion, going on within the same muscular tissue. It is no rare occurrence in men who have undergone great fatigue, to find themselves surprised by muscular twitchings, whenever they lie down to rest; such twitchings are a sure sign that the natural, healthy stimulus towards repair has been over taxed, and has degenerated into morbid tissue irritation.
Well, under all such circumstances, where the history of the case points to physical overwork as the primary cause of a choleraic attack, or, indeed of any other similar attack of acute collapse, we may look upon Veratrum as the most appropriate homoeopathic remedy. Of course, we should before all make sure, that we deal with a paralytic form of cholera.
I have purposely kept the other part of the pathogenesis of Veratrum, concerning vomiting and purging, in the background; because it is my conviction that its significance has been magnified in our school, at the cost of such consideration, as I have laid before you. The fact that Veratrum is capable of causing serous ejections from mouth and rectum is no doubt a most valuable additional hint to us to use the drug in cholera; especially so, since we now positively know that, similar to cholera, no signs of inflammation are found in the alimentary canal after death. But for all that Veratrum could have done as little for us in cholera, as Iris Versicolor, Elaterium, Croton Tiglium, and many such other drugs characterised by watery dejections; they all serve to good purposes in choleraic diarrhoea, or in the diarrhoea preceding cholera; but are incapable to cope with cholera, whenever distinctly pronounced. That Veratrum can do, and has done more for us in certain forms of cholera, although the evacuations occurring under its toxic influence are far from being choleraic–in fact they are invariably bilious–is simply owing to its ulterior action on the heart and the vaso-motor nervous system; and this action of it may be utilised in any form and in any stage of cholera. In one particular respect Veratrum is actually inferior as a homoeopathic remedy in cholera to the above mentioned Elater or Croton; this is notably the case in diarrhoeic cholera. This kind of cholera invariably begins with diarrhoea, the vomiting setting in later on. The pathogenesis of Veratrum shows, however, that the digestive canal whenever affected by the drug, manifests its first disorders by vomiting; purging may follow or may be absent altogether; at least there are some such cases of poisoning on record. At the same time we have one reason more why Ricinus is the more adapted remedy in diarrhoeic cholera. The purging and vomiting of a watery character of Veratrum come on suddenly unlike the purging and vomiting of Ricinus which begin with bilious discharges, gradually merging into choleraic evacuations. Sudden attacks of cholera with its characteristic ejections should, therefore be treated at the beginning with Veratrum, and Ricinus should only be resorted to after Veratrum has failed. In other words, Veratrum may, in many cases, be better fit to check a choleraic attack than Ricinus.
Even the spasmodic form of cholera may require Veratrum in some of its advanced stages, when the heart begins to flag and to give out unmistakable notes of failure. Experience has, however, taught that the action of Veratrum is too evanescent to be able to cope with a collapse of cholera, when coming on at the final issue of the disease. It remains to be seen, if we could do better by substituting the alkaloid Veratrine at the place of the tincture of the root of the plant hitherto exclusively in use in our school. I carry alkaloid with me in two different attenuations, the 3rd decimal, and the 3rd centesimal, with a view of seeing if the same could be made to act in a more satisfactory manner, whenever indicated, than our Veratrum dilution. For want of sufficient experience, I am, however, unable to say anything definite on the subject. We have seen from cases previously given how satisfactorily Camphor acts, even in deep collapse, provided the same has been owing to spasmodic arterial contractions; I can, therefore, hardly believe, that Veratrum should not be as useful in collapse owing to a paralytic condition of the heart. Perhaps we give the remedy at too long intervals. Dr. Carroll Dunham recommends it to be given like Camphor, every five minutes. Much of the disreputation of the drug in collapse may also be owing to its not having always been administered at the right place and according to right indications.
Here is a case to the point recorded by the late Dr. Russell: A visitor applied to me to see with him–to use his own expression–a hopeless case, which he had just discovered. In a room I found a woman quite alone, and lying on the floor; she looked exactly like a person who had been drowned, and just dragged out of the water; and excepting a low, hoarse cry `cramp cramp! she was indeed, to all appearance, dead. Her garments were saturated with perspiration; and this cold clammy sweat bathed her face and limbs, both of which were cold as marble and shriveled. Her eyes deeply sunk in their sockets, were turned up; her tongue cold, and her pulse no longer perceptible. The alvine discharge was still welling from her. As the visitor, Mr. Farnum, lived very near, he volunteered to give the medicine himself, and to watch the case, if I thought there was the slightest chance of saving her life. Veratrum of the 30th dilution was given, as the remedy best indicated in this moment. The happiest effects followed a repetition of this medicine, and of others, when they were successively called for. By the judicious care of the visitor, and the assistance of Charles Corbin who afterwards assumed the case, the woman became perfectly restored to health. Nor is this a solitary instance of the brilliant effects of our remedies when properly administered. I saw several not dissimilar cases, terminating successfully under the hands of other practitioners.
We are apt to accuse the remedy, the dilution, the inadequate repetition of the dose, whenever we fail to cure; to accuse our own self, and the ignorance innate in us, is the last thing we ever think of. I myself in writing down what I have just read to you about my suggestion regarding Veratrum, have allowed my pen to run in the same groove of error; and I just let it stand as it is, in order to give you a fair specimen of the vicious habit which is in us. There is no doubt a good deal of truth in the suggestions I ventured to make concerning the drug under discussion; but a good deal of truth may just as well mean a good deal of error at the same time. Let us apply ourselves to the right understanding of a drug’s action; to its rightful application in a given case, and the chances are, we shall in this way achieve by far greater therapeutic results, than by mere change of dilution, or by mere substitution of an alkaloid to the original drug.
One thing we must not forget in connexion with Veratrum; it is not, what we would call a protoplasmic poison, like Aconite, Camphor, Tartar Emetic, Hydrocyanic Acid and many more, and should, therefore, not be relied upon, in cases of severe collapse, unless it is, of all the other drugs at our disposal, the most homoeopathic. Dr. Russell would certainly not have selected Veratrum in the above case, had it not been that the cholera process proper, was still in full working order. The continual drain from the bowels, pointed to no other drug at his command, but Veratrum. As far as the last symptom is concerned, we have now in Ricinus a far more reliable, because in a greater degree homoeopathic, remedy. But, let us not forget, that the cardiac depression under the toxic influence of Ricinus is owing to the serous drain on the system, while in the case of Veratrum and its analogues, cardiac depression is idiopathic, and may actually help to keep up the watery discharges from mouth and rectum. The true reason why Veratrum has proved impotent in far advanced cases of cholera collapse appears to me to be this, that the pathological condition in such cases, is seldom restricted to a sphere within reach of Veratrum. Cholera may begin with distinct symptoms of cardiac paresis of the nature and origin pointing to Veratrum, and this state may, for a considerable time, during the progress of the disease, be the chief factor of the whole disorder. Sooner or later the condition of the patient will, however, in most cases assume a more complicated feature; the neurotic element will make itself felt, and aggravate the original state, and Veratrum will no more be indicated, because it does not cover any more the whole range of the pathological disorder, knowing as we do, that this drug has hardly any direct action on the nervous system.
