As soon as the first signs of threatening paralysis of the heart and its arteries manifest themselves–which can only be ascertained by a careful physical examination then then great indication arises, to administer such remedies which are capable of warding off the dreaded exhaustion of the cardiac action. We do not require, in order to attain this our aim, any stimulants or nervines; nor any of those famous spirits and ethers. Guided by the results of physiological pharmacodynamics, we are in possession of a few remedies that go far beyond anything we could ever attain by any amount and any contrivance of stimulation. Foremost amongst them is Tartar Emetic. It corresponds to the disease in its farthest development, especially when there is still much vomiting with great efforts and intervening fainting fit; when the patient, in consequence of venous cerebral congestion, falls into a state of sopor, showing however full consciousness when spoken to; when there is much praecordial anxiety with oppression of, and a feeling of burning, in the chest; when the patient lies there, motionless, in consequence of extreme exhaustion, hardly having strength enough to answer a question; when he often moans and groans;–to which I would add: when the number of respirations per minute is very small. With regard to the alleged cerebral anaemia of Tartar Emetic, further evidence would be required if the symptoms produced by the drug might not point to cerebral anaemia, known as it is that cerebral hyperaemia and anaemia show in many respects similar symptoms.
It would be erroneous to think because the choleraic vomiting is, in the first instance, not cerebral, therefore it is never so; in the progress of the disease the emetic centres may become irritated to such a degree, that this irritation keeps up the vomiting, after calm has been established at the original seat of the disorder. And this sort of vomiting will find in Tart. Emet, its homoeopathic remedy.
When we now remember, that the diarrhoeic form of cholera almost invariably ends in collapse characterised by threatening paralysis of the medulla oblongata, and that cholera of the spasmodic variety may end in this way-we shall understand the importance of Tart. Emet. in cholera.
I remember some eight or ten years ago there was a severe outbreak of cholera during the cold season, in Kidderpore–a suburb of Calcutta. It was considered to be one of the most unmanageable outbreaks, yielding to none of our well-reputed homoeopathic remedies. I saw one such case in an exceedingly far advanced stage. The patient was an elderly woman, and I could not help expressing my surprise, when I first saw her, at having been called at all, the case looking as if nothing was any more left to be done. I heard, however, that she was in that dying state for the last twelve hours. Breathing stertorous; number of respiration per minute about 6 or 7 (paralysis of the pneumogastric nerve); now and then sighing; heart’s action slow; impulse hardly perceptible, second sound especially so; coma so marked that the homoeopathic practitioner in attendance had administered Opium; now and then some strange grimaces, denoting a sensation of nausea; vomiting and purging had ceased some hours ago; unconscious when spoken to, unless the question was repeated a few times in loud voice; no answer, not even by signs, but simply some vague expression, that she is aware that a question has been addressed to her. I gave her Tart. Emet. 3 centesimal, a sip of the mixture to be repeated every quarter of an hour, and to be given at longer intervals, as soon as the first signs of improvement should show themselves. I saw her again after about 4 or 5 hours and found her much better in every respect. Breathing easier, number of respiration increased; consciousness fully returned, asked for water, and complained of excessive weakness. She finally recovered.
This case brought me, for the time being, some more cholera cases in the same quarter. I had the opportunity of seeing some patients at the earlier stage of the disease. In all of them there were hardly any spasms, but beginning failure of heart’s action, coupled with a state of somnolency; there was no anxiety, nor any restlessness; matters were taken easy, as if it could not be otherwise. Tartar Emetic proved in all these cases the specific remedy.
Strange to say, this cholera outbreak had been preceded by a severe outbreak of small-pox. Variola had just gone out to all appearance to make room for cholera; and it remains an open question with me up to date, in how far the genus epidemicus was here influenced by the foregoing small-pox outbreak, known as it is to us, that Tart. Emet. is homoeopathic to both these pathological disorders. I am not prepared now to enter into speculations on the subject; but would strongly advise you, to keep Tart. Emet, before your mind, at a similar contingency, which is after all not rare in this country.
I close this subject with the following quotation from Dr. Ringer’s Hand-book of Therapeutics:-
In antimonial poisoning there are great motor and sensory paralysis and loss of reflex action. The loss of reflex action and motor power Radziejewski shows, is due to the effect of the Tartar Emetic on the cord. This salt also powerfully affects the heart, in the frog slowing and then arresting it in diastole; and it affects the heart of warm-blooded animals in the same way. The arterial pressure falls greatly. Whilst the pulse is slow the diastolic pauses are long, but each beat influences the mercurial column of the cardiometer five times more than normal. After a large dose the pulse at last becomes very frequent and feeble, and the heart stops in diastole. Tartar Emetic directly affects the heart; affects it even when the heart is removed from the body. Radziejewski has shown that the ends of the vagi are paralyzed, and Ackermann that the contractility of the cardiac muscle is destroyed. (Wood).
In the Journal of Physiology I have published in connection with Mr. Murrell some experiments showing that Tartar Emetic, like Potash Salts, Arsenious Acid, Aconitine and Hydrocyanic Acid, is a protoplasmic poison which destroys the functions of all the organs of the body in the order of their vital endowments… Our experiments confirm the conclusions of previous observers concerning the action of Tartar Emetic on the muscular substance of the heart.
We have thus shown that Tartar Emetic paralyzes the central nervous system, the motor nerves, the muscles, and destroys sensation and, therefore, we are led to infer, that probably Tartar Emetic is a protoplasmic poison, destroying function in all nitrogenous tissue. Our experiments, however, fail to show, whether it manifests for all nitrogenous tissues an equal affinity, or whether it has a special action on some.
As in the case of Potash Salts, Arsenious Acid and Aconitine, Tartar Emetic, we suggest, weakens or paralyzes the heart through its action on all the tissues, ganglia, nerves, and muscular substance of this organ, affecting first the ganglia, then the nerves and last the muscular substance.
To this long quotation I have only to add that, while all those above-named drug substances are no doubt great paralyzers of function, they are, each in its own particular way, great tissue or protoplasmic irritants, and that they are more clearly distinguished from each other by their last mentioned physiological action than by the first.
As Carbolic Acid is a paralyzer from the beginning to end, it should find a prominent place in the collapse state paralytic cholera (Compare first footnote App.II).
Arsenic, as you will remember from a previous lecture, has no less, in its toxicological versatility, symptoms similar to Tartar Emet. We have seen that instead of acute inflammation of the digestive organs, which would prove that fatal in four or five days, these symptoms are almost or entirely absent in some cases of arsenical poisoning; and profound coma sets in from which the victim never awakes, but dies in a few hours, the mucous membrane of the stomach and intestines being free from inflammation. In how far we may make use of these arsenic symptoms, on homoeopathic principle, in the paralytic variety of cholera I am not prepared to say. But in the coma which sometimes closes the scene in cholera, Arsenic, possibly the Bromide of Arsenic or Cuprum (compare pp.150-51), should be given instead of Opium, if, indeed, medicines can do anything at all in such advanced stages. Ether should be tried in such cases, especially when the heart’s action is still proportionally strong while there are cerebral hyperaemia, stertorous breathing and threatening paralysis of the respiratory centres. In this respect Ether resembles Tartar Emetic, but in the latter the heart’s action is weak and its arteries are paralyzed, while just the contrary obtains in Ether, the heart and arterial vessels being active till the last, and even after respiration has ceased. Ether produces diabetes. In diabetic patients affected with cholera of the above described state of collapse, Ether may be our only sheet anchor. Not always, however, is the coma owing to hyperaemia of the brain; the coma may more over be due to a state of hydrocephaloid. The brain substances being shrunk because of the loss of its watery part, the blood vessels deprived of their usual pressure allow the blood to transudate. The state of the bloodvessels themselves may be sufficient to account for such a transudation. The forehead in such cases is mostly cold and clammy. Veratrum Album and Helleb. Niger, should be thought of in such cases. The coma my be owing to brain exhaustion, then Lime might be administered. On the other hand, it had been mentioned before, that the very anaemic state of the brain may produce a release of pressure on the cerebral mass, the blood-vessels being empty and flabby. Cerebral irritation would then ensure. Zincum is homoeopathic to both conditions; it stimulates primarily and depresses secondarily. China is here another remedy to be thought of, and if this fails Calcarea Phosph.
