FOR convenience of describing the medicine in the treatment of cholera it is usual with authors to divide the disease into various stages. It is not exactly true that these stages appear one after the other in regular succession as described in the books. O the contrary, we often find one stage merging into the preceding or succeeding stage. We cannot always expect to see the disease phenomena occur in regular successive order.
However, all writers on cholera agree in recognizing four stages of the disease: first, the premonitory stage, or, as it is sometimes called, an incubation; second, the stage of evacuation, or full development; third, collapse; and fourth, the stage of reaction. We shall describe the treatment in this successive order, reserving complications and sequels of the disease till the end.
The number of remedies in actual cholera is not very large. Hahnemann was the first to suggest Camphor, Veratrum and Cuprum, and this suggestion is so simple that there is no difficulty in treating the disease effectually.
In the premonitory stage we are not in a position to say that these symptoms would lead to such a serious disease as cholera, and so no particular medicine is prescribed or a physician’s help deemed necessary. If there is some diarrhoea, it can be easily checked by the timely administration of a few doses of Camphor or Phosphoric acid or Podophyllum.
If the patient is complaining of malaise, pains in body and chilliness, we can give Aconite, and if there be no appetite and the bowels are irregular, regulation of diet and rest are all that is necessary. When purging and vomiting of “rice-water” takes place, or, in other words, when the second stage is fully established, no times should be lost in selecting and administering one of the following remedies, according to the state and symptomatic indications of the case.
Veratrum alb.
Camphor, Cuprum met, or acet, Ricinus, Jatropha, Euphorbia, Croton tig, Antim. tart. Elaterium.
Veratrum album may be considered as the type of a class of remedies which are more or less potent in checking undue evacuations and bringing them to a natural color and consistency. In fact, by their timely administration, any further mischief may be averted. In such cases of these medicines should be selected in accordance with the symptomatic manifestations of the case.
Veratrum album.-We are familiar with the fact that white Hellebore is a drastic purgative; so, according to the laws of Homoeopathy, it is a medicine per excellence for choleraic evacuations, both purging and vomiting. From our repeated personal experience we can give Veratrum the highest place in the developed stage of cholera. Our late lamented Professor Farrington says, “Veratrum seems to act prominently on the abdominal organs, acting probably through the splanchnic nerves. When these nerves are paralyzed, the bloodvessels become overcharged with blood and pour forth their serum. The prostration, the coldness and the terrible sinking sensation that belong to Veratrum, all start from these nerves.”.
Indications for Administering Veratrum.-Vomiting and purging of a large quantity of serous fluid-rice-water evacuations, as they are called; colicky pains through the abdomen, with cramps in the extremities, especially the calves of the legs; great prostration; cold sweats, especially on the forehead; coldness and blueness of face and hands; great thirst for large quantities of cold water for acid drinks.
In times of cholera outbreaks it is wise to give Veratrum at the first appearance of diarrhoea, so that no further and serious development would take place. In such cases Veratrum has a marvelous effect. It is true that in Veratrum poisoning the stools are not always choleric; they are sometimes tinged with bile, and there is no total suppression of urine. Whatever maybe the toxicological effect of Veratrum about the evacuation, our clinical experience with this drug is very extensive. We can confidently give this medicine in all sorts of evacuation.
In cholera, general depression of strength is very great, and here Veratrum is also our sheet anchor. Hahnemann gives us the following picture of Veratrum poisoning in his Lesser Writings: “two children took while Hellebore by mistake.
A few minutes after taking the drug they became quite cold, fell down, their eyes projecting like those of a person in a state of suffocation, the saliva ran continually from their months, and they seemed devoid of consciousness. I saw them half an hour after the accident, and when I arrived both seemed at the point of death, distorted, projecting eyes, disfigured, cold countenance, relaxed muscles, closed jaws and imperceptible respiration”.
As regards dose, I generally commence with the 12x, and subsequently to the 30x. Our next great anti-choleric remedy is:.
Camphor.-It is generally used in the first state of diarrhoea, and also sometimes in the stage of collapse. Body is cold, voice husky, prostration very great. In times of outbreak as soon as a patient is passing diarrhoeic stools, no time should be lost in administering Camphor. At this time one to five drops of the Camphor solution after each stool is all that is required, and we are almost sure of checking the further progress of the disease.
Hahnemann says: “In the first stage Camphor gives rapid relief, but the patient’s friends must themselves employ it, as this stage soon ends in either 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 the spirit of Camphor (made with one ounce of Camphor to twelve of alcohol) on a lump of sugar or in a spoonful of water.”.
“The quicker all this is done at the first onset of the first 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.”.
What Hahnemann said above I had several opportunities of witnessing in my own practice. In my younger days, when I was consulted in the beginning of an attack, I was almost invariably successful with Camphor alone, but later on I had scarcely a case when I had the opportunity of administering Camphor with success. Dr. Rubini, of Naples, was immensely successful with his preparation of Camphor (equal parts of Camphor and Alcohol), and I believe he treated his cases from the beginning with Camphor.
Cuprum.-This medicine may be used in all stages of cholera; especially it is very efficacious in the developed state of the disease. It has the power of checking purging and vomiting, and is preeminently useful in cutting short the distressing and painful cramps in various parts of the body. Hahnemann placed great reliance in this medicine. He sometimes advised us to give it in alternation with Veratrum.
Our late lamented Dr. B.L. Bhaduri, who had treated more cases of cholera than anybody in India, used to say that he could treat nearly all his cases with Cuprum alone. He was very fond of Cuprum ars. in the stage of collapse with purging, vomiting and cramps. Drs. Drysdale and Russel spoke highly of it and so did Mr. Proctor. This latter gentleman treated ninety-eight cases of fully-developed cholera with this drug, and was satisfied with it. He writes: “For the cramps it is unquestionably the best remedy, and I must say for the vomiting also. In the stage of collapse I gradually found myself trusting to Cuprum, and the impression is very strong in my mind that in collapse it is the most valuable of our remedies.”.
Indications for Cuprum.-Purging and vomiting up rice-water fluid; colic of a paroxysmal nature; constant restlessness; cramps in the extremities, beginning in fingers and toes; great exhaustion; icy coldness of hands and feet; quick, rattling and short breathing almost imperceptible, weak and thready pulse; pale and sunken features; great thirst, water runs down with a gurgling noise; relief of vomiting after drinking; scanty or entirely suppressed urine.
I prefer the higher dilutions, from 12th and upwards. I have seen aggravation form the use lower dilutions in several cases.
Cuprum Arsen.-This combination of copper and arsenic is very efficacious in cholera. Dr. Hale first draws our attention to its use in cholera cases. He says, in his New Remedies, “I first used it in some severe cases of cholera in the year 1867 and 1876. These cases were marked by the usual intestinal disorder, to which were added severe and painful cramps in the abdomen and extremities. The alternation of Arsenic and Cuprum did not prove as satisfactory as I expected, but the use of Cuprum ars. in sixth trituration in water for children, and dry on the tongue in adults, generally acted promptly. I can recommend it in cholera infantum, spasmodic and neuralgic pains in the bowels, accompanied by screams, and cramps in the fingers and toes, attended with great debility and threatened collapse.”.
