Cholera-its curative treatment
By P.C. Majumdar, M.D. , Calcutta, India.
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.".
I can bear testimony to its efficacy in many serious cases of cholera.
Allied to Veratrum and Camphor are quite a large number of medicines more or less applicable to cholera evacuations, and these are Ricinus, Jatropha, Croton tig., Euphorbia and Elaterium. Among these we had a very satisfactory result from Ricinus in the epidemic of 1883. It is useful in cases of diarrhoeic cholera. We have numbers of cures reported in the India Homoeopathic Review of that year. I used it in diarrhoeic cases where the disease took its origin from indigestion or simple diarrhoea. In a big family in Calcutta there was an outbreak of cholera, and three persons died of it, though Homoeopathic treatment was had recourse to from the beginning. I was called when a fourth case appeared, and I at once hit upon Ricinus, which had a marvelous effect in restoring the patient to health. In the very house I had to treat four more cases, and all of them were saved by the timely administration of Ricinus. In this house there was a medical student, who asked me the name of the medicine, and learned that it was Ricinus. He remarked that in all pervious cases which died Veratrum, Camphor and other medicines were given. Ricinus surely is a new medicine. He gave the credit to Dr. George Johnson, who promulgated the Castor oil treatment of cholera.
Indications for Ricinus-Purging and vomiting of rice-water fluid; cramps in the extremities; there was scarcely any pain in abdomen; extreme prostration; complete suppression of urine; pulse almost imperceptible; slight coldness of the hands and feet.
In Ricinus cases there is a gradual sinking of the vital power; in Veratrum and Camphor it takes place rather rapidly. The stools may be sometimes tinged with bile. If the disease takes its origin from transgression in food, Ricinus is so much more indicated. I am in the habit of using the 6x dilution, repeated after each stool.
Jatropha is sometimes efficacious. It produces depression of the heart; vomiting is more prominent than purging.
Jatropha-Whitish vomiting, copious and like white of egg; stools in gushes, gurgling and rumbling in the bowels; cramps in the extremities; pains and burning in stomach; coldness of body; slight perspiration and thready pulse; "watery diarrhoea, as if spurted from him." The very alarming symptoms are not marked in Jatropha, and the patient is devoid of any anxiety for his future, but is rather lively and cares nothing for his suffering and disease.
Euphorbia is another medicine closely allied to Jatropha. In fact, it is a remedy for simple choleric diarrhoea and not for cholera proper. Both Jatropha and Euphorbia I use in the 6x dilution after each stool.
Croton tig. is also a medicine for diarrhoea, but it often cuts short the disease, which may be developed into actual cholera. Stools are yellow, watery, passed forcibly like shot, worse after food and drink; there is deadly nausea; vomiting eczema, Croton is a good remedy; dilutions from 6x to 30 used.
Very closely related to Veratrum is Antimonium tart. Its indications are very much like those of Veratrum alb. Practically, when I find Veratrum fails I resort to Ant. tart. Purging of rice-water stools; vomiting with great effort; cold and clammy perspiration; drowsiness, with complete exhaustion; pulse almost imperceptible or nearly so; heart's action failing; respiration labored and difficult. When there is an epidemic of small-pox prevailing, it is better to give Ant. tart. in the beginning of an attack of cholera, as it is alike efficacious in both diseases. We have seen it act beautifully.
These are the principle remedies in developed stages of cholera. They are more or less efficacious in checking the cholera evacuations, and thus bringing the case to safe and sound grounds.
In what is called English cholera, or cholera morbus, I found Iris versicolor or useful remedy. When vomiting is predominant and distressing, with acid rising, burning throughout the alimentary canal from mouth to anus, I frequently had to resort to it. In the case of a young gentleman in a suburban town of Calcutta, I got a charming effect from Iris. The attending physician there tried all cholera medicines to check purging and vomiting of bilious and acid matters, with burning in stomach, without any effect for two days. I gave him Iris vers. 6x, and in a couple of hours he was almost cured.
Now, if the evacuations are not stopped, or case after a considerable damage to the constitution of our patient, the case goes on to the next stage. I mean the collapse stage. In this stage the patient is on the very verge of death. But, as Homoeopaths, we must not lose heart even in this stage. In this stage the patient is on the very verge of death. But, as Homoeopaths, we must not lose heart even in this stage. The following medicines are to be thought of now:
Arsenicum alb. Aconite. Camphor. Carbo. veg. Cuprum acet. and Ars. Hydrocyanic acid and Cyanides. Cholera (Naja). Secale cor. Veratrum alb. Antim. tart.
Practically, a great deal of difficulty would arise in treating this stage of the disease. We have a great many medicines so closely analogous in their symptomatic indications that it is very hard to say which is most appropriate. However, if we can examine our patients more minutely, we can come to a definite selection.
Arsenicum album is the most important medicine in the collapse stage of cholera. its pathogenetic symptoms are so much like cholera symptoms that an arsenical poisoning case may be mistaken for a genuine cholera case. It has a vast range of action, and we have repeatedly verified its curative virtues in most serious cases of cholera. It is for this reason that I select it as a prototype of collapse remedies. Its symptoms are very marked and unmistakable. Great irritability, associated with profound exhaustion, is the prominent characteristic of Arsenic. You will see patients whose pulse is no longer perceptible; great weakness; even unable to utter a single word; yet so restless, irritable, and anxious that you will be surprised.
Indications for Arsenic great anxiety and restlessness; fear of death; utter prostration of strength; sunken eyes; distorted face; pointed nose; cold and clammy perspiration over the whole body; burning of the whole body; unquenchable thirst and vomiting after drinking; drinks often but little at a time; violent burning of the stomach and abdomen; urine completely suppressed.
When cholera attacks come on after eating much unripe fruits, drinking much ice water, living in a damp place and exposed to a putrefactive and offensive smell of decaying animal and vegetable substances, Arsenic should be selected at once.
Lower dilutions of the medicine are not so efficacious as the higher. I generally give 30th decimal in frequently repeated doses until favorable symptoms are observed. I have many a time saved desperate cases of cholera by giving the 200th dilution when lower and 30th had failed.
Arsenic has been administered indiscriminately without reference to its indications. This is a bad practice and harmful. it is for this reason Dr. Bell says "that Arsenic does more harm than good in the hands of ignorant persons."
Camphor has been used in cases of collapse, but I have not used it very frequently. It may be given in following indications: Diarrhoea and vomiting; sudden prostration; coldness of the surface; cold sweat; bluish countenance; husky voice and violent cramps. It should be cautiously given an as soon as improvement is perceptible and warmth returns it must be stopped.
Aconite is pre-eminently one of the best remedies in the collapse stage of Cholera. Dr. Richard Hughes remarked that in our day Aconite will be a valuable medicine for cholera. This was written long ago and I think that day is come and Aconite is used extensively and with good results.
Indications-Great anxiety and fear of death; icy coldness of the whole body; cold perspiration; great thirst; labored respiration with pains and oppression of chest; pulse quick, thready and scarcely perceptible; heart's action weak and slow. In cases of violent cramps and pains in abdomen it is one of my great helps. An elderly lady had an attack of cholera a few years ago with collapse and unbearable pains in the epigastric region. Many Homoeopathic remedies had been tried without effect. I found her in great agony and gave her Aconite 1x every half hour and after two days she was relieved of her pains and reaction took place. For cholera in warm days and cool nights and after exposure to cold I find Aconite valuable.
Carbo Veg is another of our important collapse remedies. I used it in many cases of impending death and with good results. When reactive power is gone it is indicated. Indications: patient lies as if dead; there is not the slightest sign of irritability about him; pulselessness; cold and clammy sweat; leaden hue of the body; husky voice; difficult and labored respiration; no thirst; no purging and vomiting; abdomen often distended; urine quite suppressed. Lower dilutions have no effect. I generally use it in the 30th and upwards.
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.
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. tar 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.
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. I thick the prophylaxis of cholera may be summed up in three cardinal points; cleanliness, temperance, and a thorough cooking of everything that is taken into the stomach. The more recently it is cooked before being taken into the stomach the better. The prophylactic remedy acts in curing the sick, in this, that its action is to bring the individual health up to par as soon as possible.
In agreed to the remedies prescribed or described here by our foreign friend, the indications are remarkably well given. As far as experience goes, I have had none with cholera, but the indications given are remarkably applicable.
J.H. HENRY, M.D : I am very much pleased with the paper of our friend from India, who represents the treatment of cholera by Homoeopathy. In 1849, when the cholera visited the United States, I was a student of medicine in New York city, and had charge of a Catholic lying-in hospital in that city. People died not only by scores but by hundreds. I was affected by the disease, but was cured by Arsenicum and Veratrum. A most remarkable thing occurred at that time. We were one night seated on a balcony discoursing about the question of cholera and its remedies. The ladies of the hospital were present. We had everything neat and clean; we had no sings of anything that would develop into cholera in the institution. Of these who were sitting on that balcony that night, every one was buried the next morning except myself.
What effect has Hydrocyanic acid upon cholera? In a practice of over forty years I have seen no effect produced by Veratrum, Cuprum, or Carb. vegetabilis upon cholera in its collapsed state. And now what are remedies when we have this extreme collapse of the whole nervous system? Our only remedy is Aconite, and for that remedy we are indebted to Dr. Hempel. Whenever you have those violent types, you must rely upon Aconite in appreciable doses.