CHOLERA, DIARRHA AND DYSENTERY : HOMOPATHIC PREVENTION AND CURE.

by John Henry Clarke, M. D.

CHOLERA, DIARRHA AND DYSENTERY : HOMOPATHIC PREVENTION AND CURE.

by John Henry Clarke, M. D.

Extraordinary member, Royal Medical Society, Edinburgh ; Fellow of the British Homopathic Society ; Physician to London Homopathic Hospital ;

Author of "Ars Medici," "The Prescriber," "A Dictionnary of Domestic Medicine," "Cold-catching, Cold-curing Cold-preventing," "Indigestion," "Rheumatism and Sciatica ;" Editor of the "Homopathic World."

PREFACE.

LIKE most generalisations, the old saying "A little knowledge is a dangerous thing" contains quite as much of error as it does of truth ; and if anything were needed to prove it, the experiences of lay homopathists in the various cholera epidemics would be amply sufficient. In view of a possible return of cholera, it has seemed desirable to reprint with amplifications an article which appeared in the Homopathic World of may last, entitled "What to do if Cholera comes", that the lay public may have within reach all the knowledge that is necessary to enable them to deal with any case of cholera that may occur in their midst in the absence of a medical man. Cholera is a disease that needs treatment at the very first onset, and if the treatment is not forthcoming, the patient may die before a doctor can be procured. It is analogous in this respect to cases of drowning or rupture of varicose veins ; anybody on the spot who has coolness and intelligence is bound to do what can be done without waiting for a doctor's arrival. It is therefore of supreme importance that all "First Aid" graduates, and, indeed, all who hold responsible positions as employers or guardians of others, should know what homopathy has done and can do with such a scourge as cholera, that they may apply it at once should the emergency arise.

That I may give a concrete instance of the value of lay homopathy in a cholera epidemic I will quote a passage from Tract 42 of the Homopathic League Series, adapted from an article on "The Cholera", by Dr. Pope, in the Homopathic Review of October 1892.

"The epidemic which prevailed at the East End of London in 1866 furnished abundant evidence of the power of Camphor to control the early symptoms of cholera.

As it is at the very commencement of the illness that Camphor is useful, its administration is, necessarily more or less domestic ; the second stage generally reached ere a medical adviser is called in, and then Camphor is of little service. Hence it is rather to clergymen, missionaries and district visitors, who during an epidemic are constantly in and out of the houses of the poor, whether ill or well, than to medical men, that we

have to look for evidence of its value.

"In an interesting and instructive account of the mission work accomplished by the late Rev. C. F. Lowder, of St Peter's, London Dock, during the epidemic of 1866, when alluding to the tincture of camphor the author writes. - ' When this was used in time, on the very first symptoms of the attack, it seldom failed to arrest the disease ; of this we had numberless proofs, as there was no difficulty in giving it at once before the medical man was able to attend the case.'

Mr Lewis, a gentleman who devoted his time to visiting among the poor in Spitalfields, distributed among them several thousands of small bottles of tincture of camphor, together with printed directions for its use. When doing so, Mr Lewis took the name and address of every applicant, and subsequently visited him. "Wherever", he writes, 'it has been resorted to early, it has been successful'.

"Miss Lowe, a lady who went to reside in a cholera-stricken district for the purpose of ministering to the wants of the poor, wrote : - 'I have to express the deepest gratitude to Mr Lewis for his invaluable gift of Camphor. He has supplied me abundantly, and I feel that there is no remedy like it, when taken in time. The Bible-woman, labouring in Holywell Lane district under Mrs Ranyard, has also been supplied, as a free gift by Mr Lewis, and can testify to many wonderful instances of its power.' "

In issuing this reprint it has seemed to me that I might enhance its value by adding a chapter on English cholera and ordinary diarrha, and another on dysentery.

JOHN H. CLARKE. 30 Clarges Street,

Piccadilly, W., June 1893.

Cholera, Diarrha and Dysentery. Part I. - Asiatic Cholera.

Chapter I. - What is cholera ? Hahnemann and microbes.

It will surprise some modern scientists to be told that the microbic theories which they now advance to explain any and every disease are by no means of recent date, and that Hahnemann was before them all in claiming for microbes the chief share in the causation of cholera.

In a pamphlet published in Leipzic in 1831 [See Lesser Writings, translated by Dudgeon, p. 489] he vigorously attacked Hufeland, who advocated the atmospheric and telluric theory. In the following passage he anticipates modern views of immunity as well as of infection.

"On board ships - in whose confined spaces, filled with mouldy, watery vapours, the cholera miasm finds a favourable element for its multiplication, and grows into an enormously increased brood of those excessively minute, invisible, living creatures so inimical to human life, of which the contagious matter of the cholera most probably consists - on board these ships, I say, this concentrated aggravated miasm kills several of the crew ; the others, however,

being frequently exposed to the danger of infection and thus gradually habituated to it, at length become fortified against it and no longer liable to be infected. These individuals, apparently in good health, go ashore, and are received by the inhabitants without hesitation into their cottages, and ere they have time to give an account of those who have died of the pestilence on board the ship, those who have approached nearest to them are suddenly carried off by the cholera. The cause of this is undoubtedly the invisible cloud that hovers closely around the sailors who have remained free from the disease, and which is composed of probably millions of these

miasmatic animated beings, which at first developed on the broad marshy banks of the tepid Ganges, always searching out in preference the human being to his destruction [He means, I suppose, having little or no effect on animals - J. H. C.], "and attaching themselves closely to him, when transferred to distant and colder regions become habituated to these also, without any diminution of their unhappy fertility or of their fatal destructiveness."

With all our microscopes and experiments on living animals (which possess a natural immunity against cholera, and are thus peculiarly unfitted for the study of this disease) we have got little further than this. That there is an infective principle there is no doubt, and that it is of an infinitesimal organised nature need not be disputed. Whether it is a comma-shaped bacillus or a straight bacillus, or a variety of bacilli, may safely be left to the microbiologists to fight over.

The thing of vital importance to know is, the conditions under which the infection may be guarded against, and how the disease may be cured when once the infection has "taken." Happily each of these points is pretty fully understood.

Habits of Cholera Infection.

Though Hahnemann was doubtless right in attributing cholera to a specific infection, he was perhaps unnecessarily severe on the upholders of the "atmospheric-telluric" theory. In all epidemics there are a number of factors at work ; and it is in proportion as the accessory conditions are

favourable that the infection spreads. It would be bold to deny that atmospheric and electric conditions have nothing to do with it. Though no quarantine may be observed, one town will escape whilst another is smitten, and that though both may be fed by the same water-supply. In India, where the disease is endemic, an outbreak in troops may be suddenly determined by the occurrence of a thunderstorm. Or the disease may-take one side of a street and spare the other, the fortunate side being the side exposed to the sun. In the outbreak at an asylum of Halle in Germany, the inmates of one wing only were affected, that wing having been built over the site of an old pond. Professor von Pettenkofer's experiments on himself at Munich go to show the same thing. He swallowed an enormous number of bacilli, but remained free from cholera ; his contention being that the condition of locality was one of the determining factors, and that in Munich, which had remained free from the disease, although in frequent communication with Hamburg, this condition was wanting.

For my part, I should define cholera as a specific fever, due to epidemic influences not well understood, and more allied to intermittent than to the eruptive fevers ; the chill stage of the fever being so intense that it overshadows all its other features.

The external chill being accompanied by internal congestion, which generally finds relief in copious evacuation by the stomach in vomiting, and by the bowels in diarrha.

Chapter II. - The Superiority of Homopathic Treatment in Cholera - An Allopathic Doctor's Testimony - Homopathy in the Hamburg Epidemic.

But there is no need to wait until the nature of cholera is thoroughly understood before undertaking to cure it. If there is one thing certain in this world, it is that thousands of lives have

saved by homopathic treatment in cholera epidemics that would infallibly have been lost under allopathy. It is a matter of the first importance to public safety that this fact should be made thoroughly well known wherever cholera may reach. The fact is attested not by homopathists merely from their experience in every epidemic in which it has been put to the test, but by allopaths themselves who have watched the treatment and its results, many having been converted to homopathy in consequence of the cures they have witnessed. Here is an extract from a letter written by Dr Macloughlin, the Medical Inspector of Stepney, Poplar, St Andrews, St Giles, and St George's, Bloomsbury, who undertook to watch the practice at the London Homopathic Hospital during the epidemic of 1854. The letter was addressed to Mr Hugh Cameron, one of the surgeons to the Hospital at that time. Dr Macloughlin said :-

"You are aware that I went into your hospital prepossessed against the homopathic system ; that you had in me, in your camp, an enemy rather than a friend, and that I must therefore have seen some congent reason there, the first day I went, to come away so favourably disposed as to advise a friend to send a subscription to your charitable fund. And I need not tell you that I have taken some pains to make myself acquainted with the rise, progress, and medical treatment of cholera, and that I claim for myself some right to be able to recognise the disease, and to know something of what the treatment ought to be ; and that there may be therefore no misapprehension about the cases I saw in your hospital, I will add that all I saw were true cases of cholera in the

various stages of disease ; and that I saw several cases which did well under your treatment, which I have no hesitation in saying would have sunk under any other.

"In conclusion, I must repeat to you what I have told every one with whom I have conversed, that, although an allopath by education, principle, and practice, yet, were it the will of providence to afflict me with cholera, and

to deprive me of the power of prescribing for myself, I would rather be in the hands of a homopathic than an allopathic adviser." - (British Journal of Homopathy, vol. xiii. P. 681).

The efficacy of homopathic treatment in cholera needs no stronger testimony than this. If more were needed, the experience of the Hamburg epidemic of last year would supply all that was lacking.

It was a matter of surprise to many homopaths that during the height of the cholera epidemic at Hamburg last summer nothing was heard of the treatment of the disease by the method of Hahnemann. It was felt that some of the representatives of our Art on the spot must have been busily engaged to the public advantage ; and it now turns out that such was indeed the case, but the work was done so quietly and unostentatiously that the caterers for the public press passed it by in their eagerness to give full details of the gruesome horrors of the cholera hospitals.

Dr Hesse, of Hamburg, has communicated his experiences to the Allgemeine Homopatische Zeitung, a translation of which, by Dr Lambrights fils, of Antwerp, appears in the February number of the Revue Homopathique Belge.

Dr Hesse is of opinion that the greater part of the population of Hamburg were more or less affected by the epidemic, the larger number only in a slight degree. At any rate, morning diarrha was a very common occurrence, and this was controlled by Sulphur. Fear of cholera was also very common, reminding us of the old story of the plague and the philosopher at Damascus. As the plague was entering the city he met a philosopher, and informed him that he had 3000 victims to carry off. As it happened, 6000 died, whereupon the sage expostulated with the demon of the epidemic : "You said you had only three thousand victims, and you have taken six." "Oh ! no," was the

reply, "I only killed 3000 ; fear killed the rest." Perhaps if he had wished to be quite exact he might have credited a few of the victims to the Damascus doctors.

There is not the slightest doubt that fear is a potent factor in the causation of disease. It is the most depressing of all emotions, and greatly lessens the resisting-power of the organism. In the Hamburg cases Dr Hesse found Arsenicum a specific when the fear of cholera was the leading element in the case. Arsenic was also the most useful medicine in the cases reported by Mr A. Paasch, a lay homopathists who, in the dearth of medical aid, volunteered his services, which were accepted by the authorities, who assigned him a district. Excluding the lightest cases, his death-rate only amounted to 5 percent. An account of his work is published in the Leipziger Populre Zeitschrift fr Homopathie, and a translation in the Hahnemann Monthly and the Homopathic Envoy for March last.

Chapter III. - Protection from Cholera by Homopathy.

Copper belts ; Sulphur ; Camphor.

RECENT observations by Professor Charcot, of Paris, and earlier ones by Dr Burq, have proved the correctness of Hahnemann's observations with respect to the medicinal powers of metallic substances in their insoluble, uncombined state. The mere application of gold, silver, copper, and other metals to the skin in sensitive subjects will produce powerful and characteristic effects ; and all persons, whether sensitive or not, who wear these metals next the skin will be brought more or less under the influence of them, although no symptoms may be produced.

In the last volume of the Homopathic World [Homopathic World, December 1892, p. 526.] I published an extract from one of the medical journals in which a practitioner related a case of copper poisoning which was almost indistinguishable from a case of Asiatic cholera. This property of copper to produce symptoms exceedingly like those of cholera renders it one of the most valuable medicines in the treatment of the disease. But, more than that, it has also proved the very best preventive.

In some of the epidemics it had been noticed, and especially by Burq ["At the Paris International Congress of Hygiene in 1878, Dr Burq referred to his researches, twenty-five years previously, which proved to him the immunity from cholera possessed by workers in copper, and said that where the question had been investigated by other observers, the same result had been arrived at. He also traced the preservation of Aubagne, between Toulon and Marseille, through every epidemic of cholera, to the fact that the large quantity of copper employed in the potteries surrounding the city produced, as it were, a rampart of copper-laden dust."- Homopathic League Tract, 42.], that workers in copper foundries were exempt from the disease, whilst all around them were being attacked.

It was this circumstance which led to the practice of wearing copper plates next the skin, a practice first adopted in Hungary, according to Hahnemann. The custom of wearing rings of copper on the toes followed by some of the natives of India may have some (conscious or unconscious) connection with its power of affording protection against this disease.

Europeans in India wear round the waist a double band of flannel, which they call a cholera belt ; and doubtless the magnetic properties of flannel may increase the bodily resisting power. But these belts have been improved upon, and the protection rendered much more certain by the addition to

the flannel of a plate copper, two to four inches in diameter. Such belts are to be procured of all homopathic chemists ; or they may be improvised by procuring pieces of thin copper plate, cutting in them slits at opposite borders, to which straps or tapes may be attached, which may be passed and fastened round the body. The cholera belt should be worn night and day. It may be cleansed from time to time by rubbing with a little vinegar. If copper in this form is objected to, the homopathic preparation of Cuprum aceticum 3 may be taken internally, one drop or two pilules three times a day.

As matters of general precaution it will be well to have drinking-water cisterns and filters cleansed periodically. Saluteris water and other table-waters of repute, natural and manufactured, should be used when there is any doubt about the ordinary service water. Care must be taken to avoid all excesses in eating and drinking, and especially eating fruit that is not perfectly sound and good. Clothing should be sufficient and warm. Especial caution should be observed in leaving off garments in warm weather, and in avoiding getting the feet wet. Those who take these precautions and provide themselves with the protection of copper need have no fear of cholera, however badly it may be about.

During the epidemic at Hamburg, Dr Hesse advised the use of Sulphur as a prophylactic. He recommended his patients to dust sulphur inside their stockings every morning when they put them on. In that particular epidemic sulphur corresponded to the symptoms of many of the cases, and would thus be specially appropriate ; but in a general way copper is much to be preferred to all other prophylactics.

Treatment of the premonitory symptoms.

Camphor belongs more to the treatment of the disease than to the prophylactic stage ; but nevertheless it has place in both. Though the symptoms of cholera come on with fearful suddenness, there are generally some scarcely noticed signs of the presence of its poison before the attack develops. The "germs" are there, but they are waiting for some favourable condition to give them their chance ; chilly feelings, griping pains, malaise, loss of appetite, slight diarrha, are all indications that the enemy is present, and ready to burst out if the patient'' vitality is in any way lowered by exposure to cold or damp, prolonged fasting, or fatigue, or loss of sleep. If, now, Camphor is taken, all this risk may be put a stop to. A couple of camphor pilules, taken every quarter or half an hour till all symptoms cease, will in the great majority of cases put an end to all risk. Armed with a copper belt and a supply of camphor pilules, the chances of taking cholera are reduced to an infinitesimal quantity.

Chapter IV. - 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 treatment 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 fr 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, 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 gives 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 if mouth be closed by trismus, and he can 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 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".

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 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 diarrha sets in means should be taken, by means of warmed cloths or a raw 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 diarrha, 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 homopathic preparation of copper) and Veratrum. Hahnemann puts copper in the first place : but later experience in routine practice has tended to reserve 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 1, 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, diarrha and vomiting continue, great oppression of chest, clammy sweat, breath appears cold to the hand of attendants, flatulent distension, failure of pulse, Carbo vegetabilis is the medicine indicated. It may be given in drop doses of N. 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. 1 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 remain still, tongue dry, red triangle at fore part, fears to be poisoned, Rhus tox. 1 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 speechless, 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 not be allowed to paralyse the bystanders. Treatment must be commenced at once. If there is a homopathic 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 utilised 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 especial service.

Among the foods that may be taken during an attack, if prolonged, and during the period of recovery, the various infant's foods are the best, as they are assimilated with the least effort. Mellin's food, Carnrick's, Allen and Hanburys', are all good, also Horlick's Malted Milk, and Koumiss. Whey Koumiss, of N. 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.

PART II. - ENGLISH CHOLERA AND DIARRHA.

Chapter V. - Description - Relation to Asiatic Cholera - Symptoms in Adults and Infants - Causes.

While in cold climates and winter weather the chief organs to suffer from atmospheric conditions are those of the chest, in hot climates and in summer the abdominal organs are mainly affected. Many persons naturally, when they take cold, instead of suffering from cold in the head or cough, have diarrha ; and in hot weather this is the more common result. Diarrha is, in fact, a catarrh of the intestinal mucous membrane, just as an ordinary cold is a catarrh of the mucous membrane of the nose. Children are more especially liable to suffer in this way. Even without any appreciable chill, an intensely high temperature is of itself sufficient to bring about a choleraic condition. All who have had the experience of voyaging through the tropics with very young children are aware of the risks they run in the confined spaces of ship's cabins, or the "tween decks" allotted to emigrants. In large cities a leading item in the summer bill of mortality is the diarrha of infants, or "cholera infantum", as it is called ; there are also a considerable number of deaths among adults from "choleraic diarrha", "sporadic cholera", "English cholera", or "cholerine", by all of which names the disorder has been called.

Of late years there has been considerable dispute as to whether there is any essential difference between Asiatic or epidemic cholera and the fatal diarrha which is always with us in summer time. The dispute is not settled yet. In all probability there is a specific difference, though all attempts to find a single specific germ of Asiatic cholera have hitherto failed ; the so-called "cholera bacillus", the comma bacillus of Koch, not being found in all cases of true cholera, and a bacillus indistinguishable from it in microscopic characters being also found in English cholera.

Robert Koch - Cholera-Expedition - Egypte 1884.

A disease answering to the description of cholera has been known from the time of Hippocrates, but there is no record of epidemics of the disease having occurred. It is not known to have spread throughout Hindustan before the year 1817, though it has existed there for centuries. The first invasion of Europe occurred in 1829. It came by way of Persia and Russia, and spread over the greater part of America. In 1845-46 it again visited Europe, reaching America in 1848. In 1853-54 it was exceedingly fatal in Europe, and again in 1866. The word cholera means "bilious", and is the term used by Hippocrates and his contemporaries to designate the choleraic disease known to them, which was probably identical with our own summer diarrha, and which they attributed to disorder of the liver.

Whatever the actual relationship between Asiatic cholera and summer diarrha may be, extreme cases of the latter are indistinguishable from cases of the former. There is the same sudden collapse of strength, evacuation of great quantities of serous fluid by the stomach and bowels - vomiting and diarrha - with shrivelling of the tissues in consequence of the liquid drain ; violent internal pins, cramps in abdominal muscles and in the limbs, with coldness and cold sweat on the forehead.

In children the onset of the symptoms is usually sudden, though there may be indefinite symptoms of illness for a day or two preceding, such as a pinched look about the features and dark circles round the eyes. The first actual symptom of the attack is generally vomiting of unaltered or cheesy milk soon after a meal ; this is generally followed by the passage of some greenish-yellow fluid containing flakes, and often undigested lumps.

There is thirst, restlessness, crying, and drawing up of the legs. The tissues become drained of fluid ; if the openings in the skull have not yet closed they will be found depressed ; and if the progress of the disease is not arrested, twitchings occur in various parts, and finally convulsions and death.

This is a picture of what occurs in typical cases, but there are all varieties and degrees of the complaint short of this extreme, just as in a cholera epidemic there are many persons who have bowel disorder which does not develop into actual cholera. The probability is that these persons are not fully susceptible to the disease, and consequently they only have it in a modified form.

Among the determining causes of an attack of summer diarrha a prolonged spell of hot weather must have the first place. Next comes a sudden change from hot to cooler weather, and in the same category may be put any kind of chill or wetting. Close, overcrowded dwellings are a prolific source of the disease among the poor.

Errors in diet are answerable for many cases. A copious draught of cold water when overheated may bring on an attack ; or eating fruit, and especially stone fruit, when not quite ripe, or when over-ripe. Fish, when there is the faintest suspicion of its not being fresh, is a dangerous food, and of all fish mackerel is the most dangerous. Even when fresh, mackerel will induce an attack with many people.

The most potent dietetic cause of summer diarrha in infants is artificial feeding, as it is very difficult in hot weather to keep milk from turning sour and keep bottles and tubes free from the germs of putrefaction. Unless special pains are taken about these matters, babies may be poisoned with their food. The practice of giving infants all kinds of ordinary food, "anything that is going", as the people say, must also be mentioned as one of the causes of child's cholera.

The epidemic of influenza - of which we are, as yet, not by any means clear - has been responsible for many cases of diarrha, some of them attended with choleraic symptoms.

In the autumn of 1891 I was asked to see a young unmarried lady of very delicate constitution, spare and very active, who in her early years, passed in Australia, had been very subject to diarrha, and in whom the tendency had returned during the same year, 1891. She had also had typhoid fever some years before, which had still further tended to weaken the bowels. The occasion of my seeing her was an attack of influenza with failure of strength, depression, headache, fever, yellow tongue,

oppression and tenderness at epigastrium, vomiting, increase in size of liver and spleen, with stitches in the spleen, and violent diarrha of light watery stools, accompanied with great pain in the back.

Podophyllum 30 in a few hours completely changed the aspect of the case, and after a little further treatment she became better than she had been for months previously.

The same medicine was the chief agent in changing the course of events in another and much more dangerous case of influenza in an elderly lady, who suffered from valvular disease of the heart. She had high fever, diarrha and sickness, intense breathlessness and attacks of heart failure. As she was living away from London at the time, an old school practitioner had been called in, and the medicines he gave for the heart had the effect of intensifying ten-fold the gastric symptoms.

At last she could retain nothing in her stomach - neither his medicine nor nourishment. I was written to about her, and sent a few doses of Podophyllum, which stopped the sickness and arrested the diarrha. She was able to take nourishment again, and gradually revived. But the convalescence was tedious.

Chapter VI. - Chronic Diarrha.

An acute attack of diarrha, or of Asiatic cholera, may, if improperly treated, leave behind it a chronic state of looseness of the bowels in those who are predisposed. Sometimes there is a constitutional tendency to looseness, and then a chronic diarrha may supervene without any acute attack. In these cases any rapid stopping of the diarrha by astringent remedies is attended with no little risk : the diarrha may be cured and the patient made worse. With the specific homopathic remedies the case is different. Their aim is to cure the patient : the diarrha will then no longer exist. It not unfrequently happens that asthma and diarrha alternate, - that is a patient has asthma when he has not diarrha, and diarrha when he has not asthma. In such cases, if the homopathic remedy for the patient is found - probably Arsenicum or Carbo vegetabilis - the patient will be cured, and he will have neither complaint. He has not two diseases, but only one with two different expressions ; and the allopathic method of "curing" the diarrha with "astringents", and the asthma with "anti-spasmodics", only keeps the see-saw going. Diarrha may be due to defect of any part of the intestinal tract, or of the glands which pour their secretions into it. Liver disease is a frequent cause of diarrha.

Here is a case in point. A good many years ago a patient, a gardener, aged about 50, came under my care in the Homopathic Hospital suffering from recurrent attacks of diarrha with violent abdominal pains swelling in the region of the gall-bladder. He had been the round of the various hospitals, both in the county and in London, and had been under the treatment of a well-known practitioner, who had painted him vigorously with iodine, but all without benefit to the patient. For many days he would be in great pain, chiefly in the region of the gall-bladder, where a swelling was to be felt. This generally increased in size until, the pains coming to a climax, he would by seized with

an attack of diarrha, the stools being mainly composed of matter and blood, and the swelling would disappear for the time. The continued suffering and drain occasioned by this malady had reduced the patient to a shadow of his former self ; and I confess I had not much expectation of doing him great good. However, after trying a number of remedies, I was led by the general symptoms to give him Baptisia in alternation with Phosphorus, and under these two remedies he steadily gained ground, and eventually became perfectly well, and has remained well ever since. He pays me a visit now whenever he comes to town, just to show himself, and tell me how many hours a day he can work, and how many miles (from 14 to 20) he sometimes can walk. I have little doubt that Baptisia had a greater share in the cure than Phosphorus, as I had given him Phosphorus before ; and Baptisia has a very marked action on the gall-bladder.

Many Europeans who have been resident in India are subject to chronic forms of diarrha. One form, called adipose diarrha, attended with white milky evacuations, is connected with disorder of the pancreas. For this, Iodine is the most important remedy. It may be given in potencies from the 3rd decimal or 3rd centesimal to the 30th.

Chapter VII. - Dietetic and General Management.

In adults the dietary suitable for an attack of English cholera is the same as that for the Asiatic kind. That is to say, during the first hours nothing but plain water need be given. If there is much collapse it should be given hot but if there is not it must be taken cold. Only small quantities should be given at a time. When the acuteness of the attack is over, milk and soda-water, Whey Koumiss No. 3, or infants' foods may be given until the powers of digestion renew themselves.

All soups and beef-teas should be avoided, as they have a relaxing tendency. The addition of isinglass, however, helps to correct their relaxing properties, and in cases of great exhaustion they may be given with this added. They are better given cold, in the jelly form, one or two teaspoonfuls at a time. All hot drinks excite the action of the bowels. During consequence mutton broth or chicken-tea may be given, and beef-tea when the looseness has entirely passed away. Plain water arrowroot with a teaspoonful of brandy in it has binding properties ; and white of egg beaten up into a froth, and slightly flavoured with lemon and sweetened with a little loaf sugar, is a most excellent form of nourishment in cases of diarrha.

In the case of children no definite line of treatment can be laid down. If one kind of food does not suit a particular child, another must be tried. Carnrick's, Mellin's, Allen and Hanburys', Nestl's, are all good, and may be tired when breast milk or cow's milk is not tolerated. A very useful substitute for breast milk is the Aylesbury Dairy Co.'s Artificial Human Milk, which I have known to agree when all other kinds have failed. But it must not be forgotten that a child will take no harm if it

goes without all food for 12 hours or more, and is given only water. In many cases of infant cholera the frequent administration of teaspoonfuls of water is the very best "food" the patient can have, until the signs of irritation have subsided.

Of no less importance than the question of diet is that of air. Plenty of fresh air is an essential requisite. An airy room that is exposed to sunlight during some part of the day is one of the best aids to recovery either of the infant or the adult. If there is great coldness, warmth must be supplied by means of hot bottles and hot flannels. The clothing must be warm but not heavy, and woollen materials are the best. Absolute rest in the recumbent position in necessary in all cases.

Chapter VIII. - Medicines.

The same medicines as are indicated in Asiatic cholera are also called for in summer diarrha ; but as in the latter the symptoms are, as a rule, less urgent and violent, so they are more varied, and call for a greater range of medicines are required as in acute when the symptoms correspond, but they must not be repeated so frequently. A dose three or four times a day will be sufficient.

Camphor is still the first medicine to be thought of when, with internal pains, diarrha, and vomiting, there are great coldness, great aversion to be covered, blueness of countenance, sudden failure of strength. As soon as the chilliness sets in, two camphor pilules every fifteen minutes will often prevent the attack from developing. If the attack is already pronounced, two drops of Rubini's tincture of camphor on a little sugar every ten to fifteen minutes, with friction of the limbs and hands with camphor spirit.

Veratrum alb. 1. - Violent internal pains, copious watery evacuations, blueness, coldness, cold moisture on forehead. A drop every five to twenty minutes.

Arsenicum 3. - Great anxiety and fear of death, restlessness, thirst, great anguish, internal burning heat with external coldness and desire for warmth, diarrha and vomiting after the least food or drink. A drop every five to twenty minutes. Chronic diarrha. Diarrha alternating with asthma in chilly subjects.

Cuprum 5. - Cramps in the limbs, crampy spasmodic pains in the body, oppression of breathing, vomiting, diarrha, restlessness. A drop every five to twenty minutes.

Cuprum arsenicosum 5. - Where the symptoms of Arsenicum and Cuprum appear combined in the same patient.

Carbo vegetabilis 12. - Offensive diarrha, great prostration, cold breath, diarrha in asthmatics, the patient cannot bear warmth of any kind. Every half-hour till relief is obtained in acute cases ; two or three times a day in chronic ones.

Baptisia 3x. - Diarrha with heaviness, pains in limbs, general soreness of the body, typhoid condition. Diarrha connected with pain in region of gall-bladder. Every two or three hours.

Bryonia 3. - Diarrha aggravated by lest motion, pains in body worse by pressure or motion. Diarrha on every spell of hot weather. Every two hours.

Colocynth 3. - Frequent watery stools, brown in colour, accompanied by colicy pains. Patient must bend double to obtain relief. Every two hours, or after each motion.

Podophyllum 3. - Diarrha and vomiting. Stool early in morning, light yellow ; great prostration. Prolapse of bowel with stool. Every two or three hours.

Mercurius sol. 6. - Slimy stools containing streaks of blood. Spongy bleeding gums ; bad odour from mouth. Every two or three hours.

Sulph. 6. - Early morning diarrha. In patients with eruptive tendency. Sinking at epigastrium worse in the forenoon. Three or four times a day.

IN CHOLERA OF INFANTS the following medicines are most frequently called for :-

Aconite 3. - Watery diarrha, crying, complaining, restlessness.

The child bites its fists. When the attack has been brought on by a chill, and is attended by feverishness. Every half-hour till improvement sets in, then less often.

Arsenicum 3. - In the same cases as Acon., when there is great weakness, pallor, emaciation, thirst, white or brownish offensive diarrha ; stools rather scanty than copious, worse after midnight or towards morning ; aggravated after eating or drinking. Nothing can be retained in the stomach. Great restlessness, anxious expression.

Apis 3. - Morning diarrha ; copious gushing yellow stools ; the child cannot bear to be moved. Brain symptoms threaten.

thusa Cynapium 3 will cure a large number of cases in which there is intolerance of milk. Here is a typical case. A short time ago I was asked to see an infant girl. 7 weeks old, suffering from diarrha. The history given me was that she had suffered from wind since her birth, and had been crying all the time, more or less, both night and day. An allopathic practitioner who had attended the mother on her confinement had been unable to do anything for the child, and the parents decided to try a change of treatment.

The child was very thin ; nothing would stay in its stomach ; milk was vomited curled almost as soon as taken. The navel was protruded with constant crying, and sore. There was irritating diarrha, the stools being light, and the water was strong and offensive. With the attack of diarrha there were convulsive movements, and drawing up of the legs. She screamed incessantly every night from 12 to 3 A. M. I prescribed thus. c. 3., a drop every two hours, and that night was the first quiet night she had since her birth. There was no more vomiting, and very little diarrha. Only three screaming attacks in the 24 hours, and these not severe ones. Subsequently the screaming became rather worse ; the child could not be pacified unless carried, and there was some intertrigo or "chafing", though the vomiting and diarrha had not returned. Chamomilla 30 soon completed the cure.

Calcarea carb. 6. - Sour vomiting, sour green stools, great perspiration about the head, cold clammy feet. A dose every hour or two till better.

Silica 6. - For the same condition as Calc. c., except that the stools are green and fetid instead of green and sour. A drop every hour or two.

China 3 (every hour or two). - Diarrha occurring after every meal, the stools being fetid, thin, and containing undigested particles.

Helleborus niger 3. - White jelly like stools with tenesmus. Frequent watery stools. Brain symptoms supervene ; twitching of muscles ; sudden relaxation of all muscles, and sinking of strength. Every half-tour till relieved.

Ipec. 3. - At the beginning of an attack where there is nausea, and vomiting of food and drink, or mucus and bile ; thirst. Every half-hour until relieved.

Sulph. 3. Or 30. - Every hour or two when the diarrha comes on early in the morning, the stools being thin, watery, and slimy.

Verat. alb. 3. - Prostration, copious vomiting so as almost to cause fainting, great coldness, cold sweat on forehead, copious loose stools, great thirst for cold water, but drinking excites vomiting, as also does the least movement. Every hour till better.

PART III. - DYSENTERY.

Chapter IX. - Dysentery : its nature, prevention, and treatment.

DYSENTERY, or Bloody Flux, as it is popularly termed, is usually the result of specific blood poisoning, which causes inflammation and ulceration of the large bowel. It is more common in tropical countries, and is in most cases traceable to drinking bad water.

It often affects armies in the field ; and travellers in malarious districts. Exposure, want, and over-fatigue are powerful determining causes, and when good conditions are not obtainable it is very fatal. Where, however, proper feeding and nursing are to be obtained the great majority of cases recover ; though in some a state of chronic dysentery is left behind, and in some the liver is affected secondarily, and abscess of the liver may result.

The symptoms of dysentery consist in the passage from the bowels of slime and blood. The motions are preceded by distressing straining ; constant desire to pass a motion, but hardly any real stool passes - only the slime and blood.

With these symptoms there is great bodily prostration, inability to sleep for the pain, thirst, and often craving for solid food, which aggravates the complaint.

Treatment. - In the management of dysentery a pure water supply is a first requisite. If the source is at all doubtful, the water should be boiled first and filtered afterwards, care being taken to see that

the filter is a new one or in good order. No solid food of any kind must be allowed. Thin gruel, barley water, farinaceous foods, milk, and the best artificial infants' foods are the best until the symptoms have subsided. Afterwards, mutton broth may be given, and with great care ordinary diet may be gradually resumed.

The avoidance of chills is a point of much importance. The safest plan is to have only woollen clothing worn. It may be as possible, according to the heat of the weather, but wool allows the perspiration to escape better than any other material without causing a chill to the body.

Another important matter is perfect rest. It is almost impossible for dysentery to get well without it, as every movement tends to keep up the congestion of the part affected.

Prophylaxis. - Among general precautions, care as to the water drunk, and the wearing of woollen clothing only, and so avoiding chills, are the measures particularly to be seen to.

The medicines specially likely to guard against an attack are Ipecacuanha and Arsenicum. Those who have to pass through malarious districts where dysentery abounds, or who reside in places where it is prevalent, should take these two medicines in the 3rd potency each twice a day in alternation. A couple of pilules of Ipecac. 3 on rising and in the afternoon ; or Arsen. 3 in the forenoon and going to bed.

Treatment of Attack. - The medicines may be given every hour if the symptoms are urgent ; less often when the patient is better.

Aconite 3. - When days are warm and nights cold. Stools small, frequent, bloody or slimy ; fever, restlessness, anxiety, fear of death.

Arsenicum. - Stools dark, putrid, mixed with blood ; during stool tenesmus and burning in rectum, great anguish, restlessness, fear of death ; extreme thirst, aggravated at night, or after eating or drinking.

Colocynth 3. - Stools bloody mucus or like scrapings ; before stool, cutting and great urging, violent colicy pains about navel, causing the patient to bend double.

Ipecac. 3. - Stools bloody or bloody mucus ; fermented like frothy molasses ; nausea and vomiting ; loathing for all food, no thirst.

Mercurius cor. 3. - Stools pure blood or bloody mucus. During stool straining and tenesmus. Severe pains in rectum after the discharge. Almost constant cutting pain in the abdomen. [This drug is at present a favourite antiseptic in the old school ; and its use has given rise to numbers of cases of poisoning, many of them fatal, with all the symptoms of dysentery ; thus proving to the allopaths themselves its homopathicity to dysentery.]

Merc. sol. 6. - Similar cases to Merc. cor. Where the symptoms are worse at night, and where there are profuse night sweats, especially on the head.

Nit. ac. 6. - This medicine follows the use of the mercurials where they cease to act. There is tenesmus during stool, and spasmodic contraction of the anus.

Long-lasting exhausting pains after stool.

Nux vom. 3. - Stools thin bloody mucus, sometimes mixed with lumps of fecal matter. Constant urging before stool. Violent tenesmus and cutting in hypogastrium during stool. Relief after stool. Worse in the morning. In intemperate people or those who have been drugged. Patient very irritable.

For relief of the distressing tenesmus, injections of linseed tea are very useful and shooting to the patient.