Symptomatic indications for Veratrum are : Cold perspiration on the forehead; coldness of the lower extremities; contracted pupils; violent thirst for cold water and acid drinks; vomiting aggravated by drinking, or by the least motion; great weakness, with feeling of emptiness after every fit of vomiting or purging. During stool especially, cold sweat on the forehead. Colic, mostly before every stool. The stools are watery (greenish) with flakes. They resemble to some extent the stools occurring under the action of Phosphorus, another drug, which is said to be sometimes helpful in removing some of the troublesome symptoms manifesting themselves in cholera. Indications of Phosphorus are: Evacuations containing grains like tallow; (and herein lies the distinction between the characteristics of the one drug from the other : grains like tallow indicate Phosphorus; flakes Veratrum) excessive thirst; vomiting after the water has become hot in the stomach; bloated abdomen, with rumbling and rolling in it. Elaterium resembles Veratrum in its action, and has been given successfully in cases in which Veratrum seemed to indicate but failed to cure. (Hempel and Arndt’s Materia Medica, 3rd edition). Colchicum is another drug worth remembering and trying in cholera patients of a gouty habit or tendency. Let us here not lose sight of Dr. Carroll Dunhum’s injunction not to administer Veratrum and Colchicum in succession. Both of the drugs just mentioned have watery stools with flakes (Veratrum) or shreds of mucus A(Colchicum) and whenever choleraic stools show a similar particularity, experience has taught me that Veratrum and not Ricinus is the remedy to be relied upon, whether there are gripes or not accompanying the vomiting and purging. The application of Ricinus in such cases is simply so much time wasted. All this I can say from experience. The Ricinus stools are rice-water like, that is to say, liquid, of the consistence of thick serum, with some little shreds floating in; they do not sink to the bottom, but remain floating. Such are the choleraic stool at the end of the choleraic process, when only small stools are discharged in a sort of passive manner, almost oozing out. Taking all considerations together it would appear that Ricinus is more intended to cope with those final discharges and to complement the action of Veratrum. Choleraic evacuations may begin in this way, and then again Ricinus should be given. But when the evacuations are characteristically choleraic, that is to say, rice-water stools, which after a certain time allow the flakes to sink, then Veratrum is the best similimum. Tartar Emetic has also rice-water stool, but there is no separation of flakes. (Compare Cyclopaedia of Drug Pathogenesis, article Antim Tart. p. 297). The flakes of the Veratrum stool sink to the bottom of the vessel and are covered by a watery fluid of the color of serum. It is not a genuine rice-water stool, for in the latter it takes time before the flakes separate from the serum and sink to the bottom, while in Veratrum the flakes are distinct and separate at the moment the stool is passed. It might be compared to a coagulated sort of rice-water. It is remarkable that such were the stools as described by Hahnemann (see p.6) and in such stools Veratrum then and now is the specific. Let us, however, not forget that these are not genuine choleraic stools; where they are, Ricinus is the remedy. The above observations lead me to make another correction. It is namely not fair to classify Veratrum against the remedies for paralytic cholera since there is a class of diarrhoeic cholera evacuations for which Veratrum is so exclusively indicated. Veratrum should be classified as pertaining, according to the feature of the case, both to the paralytic and diarrhoeic cholera variety. Aconite is the first in representing the paralytic variety, Veratrum and Tart. Emetic come next. On the other hand, we have seen from another note that Veratrum is not altogether a muscular paralyzer, that it is, moreover, capable of producing spasms. So that on the whole one drug has in its pathogenesis a good many feature, touching at all the three varieties of cholera.
In passing now to the next analogue of Veratrum, I shall begin by quoting to you from Dr. Bell’s Therapeutics of Diarrhoea: Although not of frequent use in diarrhoea, Tartar Emetic will repay careful study. Veratrum has doubtless been given many times, where the choice should have fallen on this remedy, as the colic, desires, and vomiting are quite similar. Tartar Emetic has, however, more drowsiness and twitching of the muscles than Veratrum.
While it is hardly possible to distinguish between the vomiting and purging as occurring under the influence of Veratrum on the one hand and of Tartar Emetic on the other, there are yet important differences to notice, even in the sphere of dynamic action, where the drugs so closely meet. Tartar Emetic. is also one of those drugs which, in certain doses is capable of causing inflammation of the gastro-intestinal mucous membrane, while Veratrum, as we have seen before, never does. The following quotation will, however, show you, that Tartar Emet. is in this respect not less adapted to cholera treatment than Cuprum for instance. Solutions of Tartar Emet. brought into the blood current, directly affect the brain and cord, especially the vagi, under whose influence the functions of the heart, the lungs and the stomach are regulated. Consequent upon these immediate effects upon the central nervous system, we observe morbid changes in the organs of blood-circulation, respiration and digestion. Thus vomiting takes place, before the inflammatory state of the stomach had yet begun to develop and considerable coldness of the body, great prostration, weakness and muscular trembling ensue, long before the strength has been consumed by the gastro-enteric inflammation spoken of. Death ensues after large doses (in man as in animals) in consequence of cerebral and cardiac paralysis, preceded by convulsions.(*Dr.Carl Heinigke’s Homoeopathische Arzneimittellehre, P.37*)
In spite of such palpable indications, Tartar Emetic has been entirely neglected in our school in the treatment of cholera. Tartar Emetic has one great fault; it has got a bad reputation as far as its therapeutic action in the disease under discussion is concerned. Hoyne says, It has been tried, but has not come up to our expectation. And so the drug is thrown out altogether from the stock of our cholera remedies. It is certainly not indicated in the spasmodic variety of cholera; a glance at its pathogenesis is sufficient to see that. Neither can we make use of its emetic quality, for the same is of purely cerebral origin in the first stage of Tartar Emetic poisoning, and too closely related to inflammatory action at the second stage of poisoning. The diarrhoea again produced under the influence of its toxic action is invariably inflammatory, in its nature. Two cases of poisoning recorded in the Cyclopaedia of Drug Pathogenesis, p. 297, show, however, full similarity to cholera in all respects, there being certainly no sign of inflammation any where. The only difference was this, that there was in the liquid rice-water stool–no separation after standing into clear liquid and flocculent deposits. All these are conditions not to be met with in cholera; the vomiting is not cerebral, neither it is ushered in by gastritis, and the same remark applies to the choleraic purging. Tartar Emetic is, therefore, as unsuitable to the diarrhoeic variety of cholera, as it is to the spasmodic form. There remains then the third, the paralytic variety of cholera; but even here, it may be said, Tartar Emetic is but seldom indicated. In this variety the circulatory apparatus may be invaded in three different ways. The heart itself may be the first sufferer; or the vaso-motor nerves may be affected, or the medulla oblongata as the centre of the vaso-motor system receive the first shock. It could only be in the last mentioned contingency that Tartar Emet. has a legitimate claim, and it must be confessed that such a casuality is rare. As a rule the centres of circulation and respiration are the last to be affected in the paralytic variety of cholera; it is either the heart, or the sympathetic ganglia which are the first sufferers, leading later on to paralysis of the centres.
Little therefore as may be the chance for Tartar Emetic in any of the cholera varieties at the commencement, or even at the first stage of development of cholera, it grows in importance in the measure as the stage of collapse approaches, provided threatening paralysis of the heart represents its main feature; Tartar Emetic being in this respect just the opposite to Veratrum Album which loses ground, as we have seen before, in the measure as the disease advances.
I am happy to say, isolated as I stand with regard to my advocacy of Tartar Emetic in certain types of cholera collapse, I am not quite alone. Dr. Kafka fully shares my views on the subjects. And with what enthusiasm does he proclaim his confidence in the drug, when indicated!
