Hydrocyanic acid is a marvellous medicine when indicated, acting promptly and often snatching away patients from the very verge of death. On one occasion, I had to attend a little girl gasping for the last breath and no power of swallowing medicines or anything. I poured a few drops of Hydrocyanic acid 3x on a clean handkerchief and held it to her nostrils and to my utter surprise I found her breathing quietly in a few minutes, and she made an ultimate recovery. it is for this reason that our esteemed colleague Dr. Mohendra Lal Sircar speaks of it in these terms: “If any remedy is entitled to be spoken of as a charm it is Hydrocyanic acid.
It would seem at times to restore animation to a corpse.” Indications: icy coldness of body with pulselessness; cadaverous expression; breathing slow, deep and somewhat spasmodic in character; breathing of the heart slow; urine and stool generally suppressed. I generally give it in the 3x or 6x dilution every half hour or more frequently.
Cholera or Naja-Tripudians.-This is a medicine from a venomous snake of India. The effect of this poison is very swift, like the rapidly destructive nature of cholera. Our learned Dr. Salzer speaks of it and Lachesis in the following words: “We administer them when respiration quickens, becoming at the same time more and more superficial, while the heart’s action is normal and still comparatively vigorous. This sort of respiration is a sure sign of impending paralysis of the respiratory is a sure sign of impending paralysis of the respiratory centre and coincides so far, exactly with what occurs under the venomous influence of snake poison.” I use it in the 6th centesimal dilution every hour or so.
Secale cor.-Another important remedy in collapse and some other stages of cholera in Secale.
Indications.-Watery, slimy and offensive stools, vomiting of water and mucus; eyes sunken; violent cramps of the calves, hands and chest; great restlessness and thirst; difficulty of breathing, pulselessness or small, slow and almost imperceptible pulse; coldness of the body, but patient feels very hot and cannot keep clothes on. I have very little confidence in Secale in the stage of collapse, but in other respects it is a very useful remedy. I am often able to relieve distressing cramps when Cuprum fails. I find it especially beneficial in that dreadful symptom-the cramps and pains in the side of the chest and more in spasm of the heart.
Appearance of menstrual flow during an invasion of cholera is a very serious matter, and in this I find Secale an admirable remedy. Typhoid conditions during and after cholera attacks are also very serious, and here Secale is powerful. Feverish heat after coldness; sleepiness with now and then restlessness or profound comatose sleep; pinched appearance; frequent and small pulse. It may be used in gangrene, bed sores, ulceration of cornea, and some other symptoms derived from low vitality of the system after an attack of cholera.
Verat, alb. is also useful in collapse state. Dr. Salzer writes as follows: “I can hardly believe that Veratrum should not be as useful in collapse, owing to a paralytic condition of heart. Perhaps we give the remedy at too long intervals. Dr. C. Dunham recommends it to be given, like Camphor, every five minutes. Much of the bad reputation of the drug in collapse may also be owing to its not having always been administered at the right place and according to right indications.”.
Ant. tart. being a depressant remedy on the heart is recommended in cholera collapse, and I often find it useful.
Another remedy is Nicotine, the active principle of tobacco. My experience is very limited about this medicine. It may be administered in collapse with cold sweat, deadly nausea and sleepiness. I give it in delirium with comatose condition.
SEQUELAE AND COMPLICATIONS.
With the reaction stage our trouble does not end. Various other ailments await our poor patient, and we must be on our guard to combat them in time. These are as serious as an advanced stage of cholera proper. Many a time we lose our patients in this stage.
Uraemia.-If urine is not voided after reaction fully sets in, we must do something for it. Some physicians are in a hurry about urinary secretion, and they get so very impatient, as to wish it even in collapse stage. That is bad. When reaction is full we must stop all medicine and wait, and if healthy signs are not present, urine not voided, and fear of typhoid state supervening, then we must stir up. Many a time the previously administered drags are sufficient to restore urinary secretion; so without abandoning them or searching after now medicines we must continue them according to symptoms.
Arsenic, Hydrocyanic acid, Tabacum and Nicotine are to be used with proper indications. But if they fail, and if there is impending congestion of the urinary organs, and subsequently of brain, we may resort to Belladonna. The use of it in the 30th dilution often gives prompt relief. Opium may be considered as one of the best remedies in this condition if there is a comatose state with uraemia. We have seen Agaricus musc. or Muscarin useful in such condition associated with pulselessness or small and thready pulse, coldness of the surface, comatose state and delirium.
If urine is collected in the bladder and there is sufficient expulsive effort but no urine voided, Cantharis 6x or 30 may be used with benefit. Failing this, and if there be some burning in the urethra, Terebinthina may be given.
I sometimes use Acidum carbolic 6x or 12x in cases of uraemic intoxication and delirium in cholera, with the following indications: Constantly agitated, uttering a piercing cry, delirious staring from sleep; tongue dry, coated with thick, yellow fur, great thirst; high fever; urine is dark, black or blackish olive-green color. Our much-vaunted Kali bich. is not a good medicine in suppression of urine in my hands.
Fever.-In the reaction stage we often meet with feverishness, and when slight we must not give any medicine; but when it assumes graver form, and there is restlessness, thirst, dry, parched tongue, and full pulse, I generally give Aconite, failing which, Veratrum alb. may be used. If there is headache, flushed face and other symptoms, Belladonna high has its place. Rhus tox., Bryonia and Phosph. acid may be administered with proper symptomatic indications. These latter three medicines may be thought of when this reactionary fever assumes a typhoid form.
Hiccough is often a very distressing and obstinate complication. Our ordinary hiccough remedies cannot find their place here. Cuprum met. and Arsen. are very frequent helps. Veratrum alb., Nicotine and Hydrocyanic acid are recommended.
In the reaction stage there may be some faulty condition of the digestive tract generally, and we may think of Nux vomica, Cicuta, Phosphor, Ignatia, Belladonna and the like. We have seen patients cured, to all intents and purposes, when they were suddenly attacked with dyspnoea and died. Dr. Macnamara is of opinion that in these cases there is formation of clots in the right side of the heart, usually extending into the pulmonary arteries. Dr. Salzer, on the authority of Dr. Buchner, advised us to give Calc. ars. 6x or 12x, but death is so sudden that nothing can be done.
After the choleraic symptoms are over we sometimes get cases of obstinate diarrhoea. In those cases, when the stools are yellow and watery, quite copious and sudden, a few doses of Croton tig. are sufficient. When stools are saffron-yellow, watery, with severe colic, Colchicum is to be thought of.
When the stools are white or yellowish-white and much prostration, Phosph. acid or Podophyllum is given. If there is tympanitic distension of the abdomen, passage of flatus, rumbling, and thin yellow stools, Natrum sulph. or China may be given. One or two doses of Sulphur, higher dilution, is sufficient to being the stool into its natural color and consistency. When there is a tendency towards dysentery, stools are greenish, with tenesmus and colic. Merc. viv. is the remedy; but when they are bloody and slimy, Merc. cor. is the preparation used.
Vomiting is often persistent and troublesome, and defies all our well-selected remedies. In such cases some bland and mucilaginous food is all that can check it. I generally give some arrowroot or rice-water salted and acidulated. Our chief remedies in vomiting are Arsenic, Ipecac, Iris vers., Phosphorous, Kreosote, etc. Other complications may be treated as general diseases.
Diet.-There is a great diversity of opinion among medical men on this subject. From broth, brandy and other nourishments to no food is the prevailing idea on this subject. From practical observations in many cases, we are of opinion that during the progressive and collapse stages of cholera no food should be given except plenty of water and ice to appease thirst and cool down the stomach. After the tempest is over, bile appears with the evacuation; and, urinary secretion established, barley-or arrowroot-water, with thin fish or meat broth, may be allowed. When there is craving for food, gradual addition of nutritious but easily digestible food should be given. The stomach becomes very sensitive after an attack of cholera, so that particular care is necessary in giving food and nourishment.
DISCUSSION.
W.J. HAWKES, M.D.: I have been very much pleased to listen to this very excellent paper on this very important subject. I believe firmly in the old adage that an ounce of prevention is worth a pound of cure, so that the hygienic and medicinal prophylaxis of cholera is of extreme importance; that the hygienic prophylaxis is of much greater importance than the therapeutic prophylaxis, for the reason that the individual can take care of himself with the prophylaxis of hygiene, while he cannot take care of himself which the prophylaxis of therapeutics. The disease is rapid, and requires prompt attention when therapeutics are required. Consequently, I would put great stress upon this hygienic prophylaxis of cholera.
