An attempt has been made some years ago to use Salicylic Acid in cholera. The remedy was brought before the public with great praise. It was at the time brought for the first time before the allopathic profession. Guided by a mere outline of its physiological action, I had the courage to assert, that this acid can never become a cholera remedy, far less a cholera specific. My prediction has, thus far, become true; nobody hears now-a-days anything of Salicylic Acid in connexion with cholera. The letter I addressed on the subject to the Englishman runs as follows:
TO THE EDITOR OF THE ENGLISHMAN.
SIR,–From an editorial in your impression of the 27th instant, it is to be seen that most favorable results have been obtained by the use of the Salicylic Acid in the treatment of cholera, which was introduced into India by Surgeon-Major Boustead, of the Bombay Army, some months ago; and that, in answer to correspondents Dr. Boustead has replied that half a grain for each years of age of patient, is a safe dose to be administered by a non-professional person, but this dose can be exceeded every hour if administered under the supervision of a medical man. As it is, therefore, likely that the above- mentioned drug will soon be extensively tried all over India in cases of cholera, both by professional and non-professional men, I believe–and I hope that you, Mr. Editor, will share with me this belief–that it is of the utmost importance that people should know something about the action of Salicylic Acid on the healthy human frame. The medicinal use of this drug is, comparatively speaking, new to the medical profession, and the following is, perhaps, the only information in existence as too its physiological action on the healthy. we owe what is known in this respect to Dr. C. A. Ewald, Assistant Physician to Professor Frehich’s ward in the Charite Hospital, Berlin, as recorded in the Practitioner of March, 1876:-
Within fifteen minutes, or even less, after the administration of Salicylic Acid, a copious perspiration breaks out, first on the face then on the thorax, abdomen, and the rest of the body, accompanied by reddening of the skin, more especially of that of the face, and may be so copious that the patients may lose 505-750 grammes of water. Almost simultaneously with the outbreak of this sweating, sometimes a little later, the temperature begins to decline, the gradual fall lasting much longer than the perspiration. Now there is, indeed, no constant relation between the fall of temperature and the amount of sweating, there being in many cases great reduction of temperature with little or no sweating. Generally the pulse and respiration are not at all affected, though the pulse may become a little slower. Where the pure acid, or the sodium salt are employed, the intestinal tract does not appear to be at all affected. The recorded accounts of irritant effects on the mucous membrane of the oesophagus, stomach, or intestines, even of erosions and hemorrhages, are due to admixture of irritant substances, such as carbolic acid, with the salicylic acid. This is shown by a comparison between my earlier experience with my later, as I have not met with any such results since using the pure drug. The evacuations, on the other hand, become more frequent and fluid. The salicylic acid appears in the urine, which is other wise unaltered, as salicyluric acid. The cerebral functions appear little or not at all interfered with, for, so far as my own experience goes, only three patients have complained of buzzing in the ears and dizziness, and only one of hallucinations. Nor such a collapse occurs as one might have expected from the great fall of temperature. I have not, nor, indeed, have any others, ever seen a fatal case of collapse and, although several patients, especially such as have sweated profusely, appear during the fall of temperature, or shortly afterwards, much exhausted, and very pale, this condition is at most rare and transitory. As it is quite possible that, owing to so great reduction of the heat of the body, a fatal collapse may occur, I have not been in the habit of giving the acid to very debilitated patients; or, when I have done so, I have, at the same time, administered analeptic and stimulating remedies.
Salicylic Acid produces, then, a reduction of temperature, a slowing of the pulse, frequent and fluid evacuations from the bowels, and, if the dose be pushed farther still, fatal collapse- – on the whole, a pretty fair pathological picture of what occurs in a cholera patient; in other words, the toxic action of Salicylic Acid on the human frame is, in its main features, homoeopathic to the action of cholera poison. Now, I do not wish to be polemic, or sectarian, in this letter, and I shall, therefore, not enter into the question as to how far the good effects of Salicylic Acid in cholera are owing to the drug being homoeopathic to the disease–as I should certainly feel inclined to think–or how far, on the other hand, those good effects be ascribable to the antiseptic properties of Salicylic Acid–an opinion evidently held by Dr. Boustead. What I wish to bring prominently to the notice of all those whom it may concern, is the fact that Salicylic Acid does produce a state strikingly similar to the last stage of cholera, and that, consequently, by pushing the administration o the drug beyond a certain limit, what has been intended to be a remedial agent must necessarily turn into a sure agent of death. If I understand Dr. Boustead’s instructions aright, a man of thirty years of age may take 15 grains of Salicylic Acid every hour. Now, this is a most dangerous way of dosing for a homoeopathically acting drug, especially so, if we remember that the acid is eliminated with the urine, and that this excretion is entirely arrested in cholera–a fact which must lead to a gradual accumulation of the drug within the system. Let us at the same time remember that in being eliminated, it acts injuriously on the kidneys. I have seen cases treated by the acid and also by salol going through the whole cholera process, till they passed water, then the urine stopped after two or three days and they died of uraemia. It would appear as if the Salicylic Acid remained un-observed, or at least partly, during the cholera process, but as soon as assimilation began, the drug being carried into the organism, began its toxic mischief.
It is greatly too be feared that, whatever good reputation the acid has acquired in the treatment of cholera, it owes to such cases where th first few doses had brought on a change for the better. Should, however, such few doses have failed to effect any good, then it is high time too remember that, however desirable it may be to neutralise the miasmatic cholera poison, Salicylic Acid is, of all antiseptic agents, the least suitable to do so; for it could only do it by aggravating the case, and extinguishing the patient altogether. At any rate, it appears to me of the highest importance that the world–professional as well as non-professional–should know that, in administering Salicylic Acid to a cholera patient, they deal, I shall not say with a homoeopathic remedy, but, at any rate, with a homoeopathically acting drug. India, as far as I can see, is in a fair way of having her cholera patients slain by the thousands, on account of the comparatively little, though undoubted, benefit some have derived from Salicylic Acid.
———– Cholera patients, have, I am happy to say, not been slain by the thousands; but Salicylic Acid has come and gone, to be heard of no more, as a cholera remedy. Salicylic Acid has, however, a specific action on the pancreatic juice, and most likely also on the pancreas in preventing the formation of Indol and Skatol. This has been physiologically demonstrated (see Brunton’s Pharmacopoeia–Article Salicylic Acid). Now for reasons evident from the following extracts, and for other reasons given in detail in a second extract (British Medical Journal, March 30, 1889) it would appear that the pancreas is the heart of the action of the cholera poison. The absence of fecal matter, characterised by Indol and skatol must be ascribed to the deficient action of the pancreas, and so must (according to the 2nd extract before mentioned) the colorlessness of the cholera stools, and their deficiency in bile, be ascribed to the faulty action of the pancreas. Salicylic Acid may, therefore, homoeopathically have an action for good in cholera. The matter should be reconsidered by homoeopaths. Moreover, instead of Arsenic we might do better to apply Arsenicum Iodium or Calcarea Arsenicum
1st EXTRACT:- THE CHEMISTRY OF CHOLERA
At last it would seem that a cure for cholera is really on its trial which is based on more rational methods than the various specifics which have from time to time been proclaimed by enthusiastic philanthropists and empirical advertisers. In this case the first step towards what is believed to be valuable discovery was made by a quiet worker in the laboratory, Professor Lowenthal of Lausanne, who had never had the opportunity of clinical experience, nor, it is believed, ever witnessed an actual case of cholera. Like all truly scientific investigators, he aimed first at ascertaining facts. Taking for granted that Koch’s bacillus was the true bacillus of cholera, he set to work to find out what was its food or, to use medical language, in what nutrient media the inactive bacillus would acquire activity, would in fact thrive and become poisonous. He made of course many fruitless and disappointing experiments. At length his patience was rewarded by discovering, to use the words of Surgeon–Major Nicholson of Patna, who communicates the information to the Indian Medical Gazette, that if the cholera bacillus were cultivated in a paste containing fresh pancreatine, it begins to secrete its virulent ptomaine which when inoculated in mice either killed them or made them intensely sick. By varying the elements of his culture mixture Lowenthal fully satisfied himself that it is pancreatic juice which in presence of albuminoid and peptonised substances determines the poison secreting action of the bacillus. This discovery at once localised the seat of activity and pointed to the place in which the initial, mischief would be brought by any bacilli which might enter the human frame., They must-some of them at least, writes the Patna doctor–escape through the stomach into the intestine, where they would find the pancreatic juice necessary to develop their poison. The great step had thus been gained. The camp of the enemy and the method of his operations had been explored; the point now was to ascertain how too countermine the attack. The laboratory was again set to work. Only this time instead of trying to find out what would bestow active life upon the bacillus, the experiments were directed to the discovery of what would condemn him to death and destruction. The problem was in fact to ascertain what substance mixed with pancreatic paste would prevent the active functional operations of the bacilli and the genesis of the toxic ptomaine. Various antiseptic agents were tried, and again perseverance guided by scientific skill met with its reward. After many failures the patient Professor hit upon Salol or the Salicylate of Phenol. Salol passes through the stomach unchanged and is split up in the duodenum, writes Dr. Nicholson, into carbolic and salicylic acids by the action of the pancreatic juice. It is death to the bacillus. Such at least was the claim of Professor Lowenthal. But as cholera subjects are happily rare at Lausanne he had no opportunity of trying his suggested remedy on a real patient.
