Dr. Nicholson, however, has had less difficulty in finding cholera victims at Patna, in which neighbourhood, when the proper time of year comes round, a crop of cholera cases is produced as regularly as a harvest of mangoes or Indian-corn. As soon as the cholera season commenced, writers Dr. Nicholson, he instructed his assistance to try Salol, administering it every three or four hours. His orders were carried out. In all eighteen patients were treated with this drug and every one recovered. Of these eleven had been admitted to hospital in the state of collapse and in many of them the symptoms were so severe as to justify a belief that under the usual treatment they would have succumbed to the disease. These facts combined with a knowledge of the scientific basis on which the remedy is supported, afford at least a gleam of hope that something like a specific against cholera may possibly have been found. Though the real merit of the discovery rests with Professor Lowenthal, DR. Nicholson appears to deserve every credit for having appreciated its significance and for the exertions he has used to bring it into practical use and under prominent attention. If further results are equally successful the government of India should feel encouraged to devote a little more of its money and attention to the importation of scientific workers and the establishment of laboratory investigation.
-As appeared in pioneer, 1890.
2ND EXTRACT:-ON THE CLINICAL SIGNIFICANCE OF CLAY-COLOURED STOOLS UNACCOMPANIED BY JAUNDICE.
At a meeting of the Royal Medical and Surgery Society, Dr. T. J. Walker read a paper on the above subject. After refering too the accepted views on the significance of clay-coloured stools, he gave two cases in which, during life, a persistent symptom was the absence of color in the faeces and in which the diagnosis made of obstruction of the pancreatic duct, with a healthy condition of the bile-duct, was confirmed at the autopsy. From these cases Dr. Walker concluded, first, that the formation or hydrobilirubin, the coloring matter of the faces, depended upon the mutual reaction of the bile and pancreatic fluid, under the influences met with the intestinal tract; secondly, that in disease a deficiency of the pancreatic fluid would, equally with a deficiency of bile, cause the pathological condition of colorless or clay-colored stools; thirdly that according to the most recent physiological researches, that portion only of the colored constituents of the bile which had been converted into hydrobilirubin was excreted in the faeces, while the unchanged bilirubin, bilifuscin and biliverdin, were absorbed; it followed that, if hydrobilirubin could not be produced without the aid of the pancreas, that organ must have an important role in regulating what portion of the bile entering the intestines should be absorbed, and what thrown off with the faces. Dr. Walker then pointed out that these conclusions received confirmation of other published cases that Clause Bernard recognised that that the pancreas had a part in producing the color of the faeces, and that the state in which the bile pigments were found in the meconium of the foetus, while the pancreatic function was in abeyance, also accorded with these conclusions. He further pointed out the fact of the pancreas influencing the excretion of the bile in the faeces would, if accepted, reconcile the discrepancy between the clinical observation that certain drugs produced copious bilious stools, and the physiological observation that these drugs had little or no influence on the secretion of bile by the liver, and that the same fact would explain these hitherto inexplicable cases in which, with no evidence of arrest of the bile-secreting functions of the liver, or of obstruction of its ducts, the symptom of white or clay-colored stools was persistently present.–British Medical Journal, March 30, 1889.
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3RD EXTRACT:-CHOLERA TREATED BY SALOL.
Dr. F. C. Nicholson, for many years the popular Senior Resident Surgeon of the Presidency General Hospital and now Civil Surgeon of Patna, after commenting on the successful use for eight years of hypodermic injections of morphia in the first stage of cholera, reports 18 cases of cholera in all its stages treated by Salol without a single fatal issue. Dr. Nicholson based his treatment on the laboratory experiments of Professor Lowenthal of Lusanne, and though he had no clinical experience of this drug, had formulated certain deductions from chemical practice which he anticipated, if given a trial, would prove an antidote to this fatal scourge. Lowenthal maintains that the cholera virus is a ptomaine resulting from the presence of Koch’s bacillus in the system. He discovered that this ptomaine is not produced in the ordinary nutrient media, but is freely propagated in a paste containing pancreatine thus proving that the pancreatic juice is the determining medium of the toxic power of Koch’s bacillus when present in nitrogenised substances. Thus, then, the morbific germs of cholera assume their potency in the alimentary canal at a point where pancreatic digestion begins.
Lowenthal also maintains that salol which is a salicylate of phenol, is by the action of the pancreatic juice in the duodenum broken up into salicylic and carbolic acids which, according to his experiments with salol in the manner described, always destroyed the cholera bacillus. Dr. Nicholson has put Professer Lowenthal’s deductions to the test, and reports a uniform success in 18 cases, which he, with his assistants, Drs.R.K.Gupta and Asgar Ali Khan, treated at Patna. Dr. Nicholson used this formula:-
Salol grs. XV, spts. chloroform m. XX, mucilage 1 drachm, water one ounce, given every 4 hours, with ice to suck, and thin sago gruel prepared in water and flavoured with salt as diet.
Dr. Nicholson sums up his careful report with the following remarks:- I think the treatment of these 18 cases affords strong clinical testimony in favour of salol in the prevention and cure of cholera, though not sufficiently numerous to prove it a specific for this dread disease. We would be glad to receive reports of an extended trial of salol in cholera–As appeared in The Medical Record, January 1st, 1890.
———— COBRA VENOM FOR CHOLERA.
The letter I addressed on the above subject to the Statesman may be read with advantage:-
TO THE EDITOR OF THE STATESMAN.
SIR,–With reference to a paragraph which appeared in your issue of this day, headed Cobra Venom for Cholera, an observation made by the late Dr. Vincent Richards may be of interest to the reader in general, and to Dr. Haffkine in particular. In his Landmarks of Snake Poison Literature (p.132), Dr.Richards states, that the ptomaines generated in the bowels of choleraic patients injected in animals produce results startingly similar too those produced by cobra bites. In connexion with the above, it is worth noticing that ptomaines are not, as generally believed, mere post-mortem products of putrefaction, but that such products may, and do often, arise during the life-time of patients, so that their disease, and eventually their death, may be owing to a kind of self-poisoning (See Professor Lander Burnoton’s Pharmacology, London 1885, p.350). Now we have heard a good deal during the last few years about the cholera bacilli and the pathogenic action of their ptomaines, to the entire neglect of the choleraic action of their ptomaines, to the entire neglect of the choleraic ptomaines. May it not be that in many, if not in most, fatal cases of cholera, there have been, properly speaking, two agencies at work, the pathogenic ptomaines of the cholera bacilli, the toxic action of which generates the disease in man; and secondly, the choleraic ptomaines to which the fatal issue of the disease is due.
Plausible as this hypothesis appears to me as it stands, I should say it derives a considerable support from the statements of Mr. Perroux concerning the antidotal virtue of cobra poison in cases of cholera, when read in connexion with the before- mentioned statements of the late Dr. Vincent Richards. In the official report of Dr. Edward C. Shakespeare, United States Commissioner on Cholera in Europe and Asia, issued at the Government Printing Office, Washington, in the year 1890, mention is made of Mr. Perroux who relates the successful employment (intravenous) of the venom, of the cobra da capello by some tribes in the north of India as an antidote, in the lethal stage of cholera of the poison of that disease. The italics are mine…In the lethal stage of cholera it would then appear that cobra poison is by no means an antidote to cholera, in other words, to the pathological process as generated by the ptomaines of the cholera bacilli; it has prove itself to be an antidote to the lethal stage, when we deal no longer with the former ptomaines but with these generated by cholera. And it acts here antidotically in its quality of a similar, or if any allusion to Homoeopathy is to be avoided in a question which is already complicated enough as it is, in its quality as-an analogue.
