TREATMENT OF AN ATTACK.
FIRST STAGE–SECOND STAGE–TYPHOID CHOLERA–DRY CHOLERA. The appalling feature about cholera is the suddenness of its attack and the awful rapidity of its course. If efficient treat- ment is not put in force at once, the patient may be beyond help before the doctor arrives. In Hahnemann’s article, published in the Archiv fur Hom. Heilkund, vol. XI., 1831 (Lesser Writings, p.844), he insists on the necessity of treatment being commenced immediately by the friends of the patient, without waiting for a doctor, and the remedy he relies on is Camphor. Here are his own directions:-
“When the cholera first appears, it usually comes on in the commencement of the first stage with tonic spasmodic character”- that is, with a continuous spasm as opposed to “clonic” or interrupted spasm, shown in jerking movements and cramps of muscles which alternately contract and relax- “The strength of the patient suddenly sinks, he cannot stand upright, his expression is altered, his eyes sunk in, the face bluish and icy cold, as also the hands, with coldness of the rest of the body;hopeless discouragement and anxiety, with dread of suffocation, is visible in the looks; half stupefied and insensible, he moans or cries in a hollow, hoarse tone of voice, without making any distinct complaints, except when asked; burning in the stomach and gullet, and cramp pains in the calves; on touching the precordial region he cries out; he has no thirst, no sickness, no vomiting or purging.
“In the first stage Camphor givers rapid relief, but the patient’s friends must themselves employ it, as this stage soon ends either in death or in the second stage, which is more difficult to be cured, and not with Camphor. In the first stage, accordingly, the patient must get as often as possible (at least every five minutes) a drop of Spirit of Camphor (made with one ounce of Camphor to twelve of Alcohol) on a lump of sugar or in a spoonful of water. Some Spirit of Camphor must be taken in the hollow of the hand and rubbed into the skin of the arms, legs, and chest of the patient; he may also get a clyster of half a pint of warm water, mingled with two full teaspoonfuls of Spirit of Camphor, and from time to time some Camphor may be allowed to evaporate on a hot iron, so that it the mouth be closed by trismus, and he swallow nothing, he may draw in enough of camphor vapour with his breath.
“The quicker all this is done at the first onset of the stage of the disease, the more rapidly and certainly will the patient recover; often in a couple of hours, warmth, strength, consciousness, rest, and sleep return, and he is saved”
There is no need to dwell on the resemblances between the symptoms of the first stage of cholera and the symptoms of Camphor poisoning. The correspondence is most striking. The violent chill, sudden failure of forces, and spasm of surface blood vessels are common to both; hence the appropriateness of Camphor to the condition. The preparation of Camphor now most generally used is the concentrated tincture of Dr. Rubini, who discovered the method of preparing it.
It must be remembered, however, that Camphor in this strength is a poison, and must be used with great care. As Camphor in this strength is not soluble in water, it is best administered on a small lump of sugar; two or three drops given in this way every five minutes is the best mode of using the remedy. At the same time friction with Spirit of Camphor, as advised by Hahnemann should be employed, and every means taken to induce the reaction of warmth and perspiration. Hot flannels, hot bottles to feet, legs, and sides, will help to restore warmth.
The heat of these should be tested by the hand of the attendant, since, if the patient is in a state of insensibility, a burn may be caused without his being able to make a sign. When perspiration has once been induced, great care must be taken to maintain it, and to avoid chilling. Hot drinks only must be allowed.
Another important point to be observed is to allow the patient to be perfectly at rest. Many a death has been precipitated by removal to a hospital. When diarrhoea sets in means should be taken, by means of warmed cloths or a draw sheet, to have the stools taken away without disturbing the patient. In a large number of cases no other remedy besides Camphor will be required; and Camphor may be given even in the second stage so long as it continues to do good, if the second stage has come on in spite of its administration in the first.
Camphor is also the remedy for those modified cases in which there is simply chill, weakness, and pains in the body with or without diarrhoea, the patient not being prostrated with the fully developed attack.
The Second Stage.- In some cases the first stage is very slightly marked, and in many the second stage has already supervened on the first before anything has been done. To quote Hahnemann once more :-
” There are cases of cholera, especially in northern regions, where the first stage, with its tonic spasmodic character, is hardly observable, and the disease passes instantly into the second stage of a clonic spasmodic character; frequent evacuation of watery fluid mixed with whitish, yellowish, or reddish flakes, and, along with insatiable thirst and loud rumbling in the belly, violent vomiting of large quantities of the same fluid, with increased agitation, groaning and yawning, icy coldness of the whole body, even of the tongue, and marbled blue appearance of the arms, hands, and face, with fixed, sunken eyes, diminution of the senses, slow pulse, excessively painful cramps in the calves, and spasms of the limbs.”
In such cases, says Hahnemann, the administration of a drop of Camphor Spirit every five minutes must only be continued as long as decided benefit is observable. The remedies he advises for the second stage are Cuprum (that is, the homoeopathic prepa- ration of copper) and Veratrum. Hahnemann puts copper in the first place : but later experience in routine practice has tended to reverse the order.
One point to be observed is, that as soon as Camphor is done with as the remedy it must be removed, as it acts as an antidote to copper and the other remedies for the second stage. The patient may still be rubbed, but not with Camphor. Pure spirit of wine or any form of alcohol may be used instead.
When Camphor has ceased to do good, or when the case has already entered the second stage before treatment is commenced, observing all the formerly mentioned means of keeping the patient warm and at rest, give Veratrum album I, two drops in a teaspoonful of hot water every five minutes until decided relief is obtained, and then lengthen the intervals between the doses.
In some cases only a very few doses will suffice to remove the patient out of danger.
Arsen. alb. 3, two-drop doses in hot water every five or ten minutes where there is great restlessness and anguish with burning thirst.
Cuprum metallicum 6, two drops in the same way, when the cramps are excessively severe.
When the patient passes into complete collapse, diarrhoea and vomiting continue, great oppression of chest, clammy sweat, breath appears cold to the hand of attendants, flatulent distention, failure of pulse, Carbo vegetabilis is the medicine indicated. It may be given in drop doses of No. 5 tincture in a little water every five or ten minutes until reaction shows itself.
Typhoid Cholera.- Sometimes cholera takes on a form resembling typhoid fever. Instead of recovering properly from the second stage, or the collapse, a state of coma sets in, with half-open eyes, delirium sometimes furious, restlessness, heat, and sweat.
When the delirium is violent, with dilated pupils and staring eyes, desire to escape, rapid pulse, Bella. I every five or ten minutes. Fever and muttering delirium, fear of being poisoned, involuntary evacuations. Hyoscy. 1 every five or ten minutes.
Pains all over, cannot bear to be moved, Bryonia 1 in the same way.
Relief to pains by movement, cannot bear to remains still, tongue dry, red triangle at fore part, fears to be poisoned, Rhus tox. I in the same way.
Dry Cholera or Cholera Sicca is the most dangerous of all forms of the disease. The full incidence of the disease is on the internal vital organs, with no relief either in vomiting or purging, which do not appear at all. There are merely great anxiety and terrific pain in the chest; the patients are speech- less, suffocated, and gasping for breath. Death follows in two or three hours unless relief is obtained. In the Hamburg epidemic Mr Paasch saved two such cases, one by the administration of Arsenic alone in the 3x trituration, and the other with Arsen. and Carbo vegetabilis in alternation.
With these medicines and measures the death-rate of cholera epidemics need not reach a high figure. The most dangerous feature of the disease is its terrible swiftness; but this must not be allowed to paralyze the bystanders. Treatment must be commenced at once. If there is a homoeopathic doctor within reach, he must be sent for; but as doctors, in the rush of an epidemic, cannot always attend at once, precious time may be lost before he can reach the patient. This time must be utilized by the friends, and then he will find his work greatly simplified on his arrival.
Under no circumstances must patients be allowed to have opiates, or to have salt solutions injected into their veins. The Hamburg mortality is a sufficient commentary on this class of practice.
DIET AND AFTER-TREATMENT.
In regard to diet, during the first stage, especially if there is sickness, nothing need be given. If there is thirst, hot drinks instead of cold must be given-hot water, milk and water, or thin barley – water. Hot coffee has been found of great use in promoting perspiration, and if the attack comes on after an indigestible meal, coffee is of special service.
Among the foods that may be taken during an attack, if prolonged, and during the period of recovery, the various infant’s food are the best, as they are assimilated with the least effort. Mellin’s food, Carnrick’s. Allen and Hanbury’s, are all good, also Horlick’s Malted Milk, and Koumiss. Whey Koumiss, of No.3 strength, will be the most suitable, as it is the lightest, and has astringent properties. Whatever nourishment is given should only be allowed in small quantities at a time.
To avoid relapse care must be taken not to allow the patient to rise from bed too soon; and the diet must be strictly regulated until the strength of the digestive system is fully restored.