Colchicum autumnale

Lecture XXIV — Melanthaceae — Colchicum, Veratrum album, Veratrum viride and Sabadilla

MELANTHACEiE.

Melanthaceae.

Veratrum album, Veratrum viride.

Sabadilla.

Colchicum.

Mind.

Abdomen.

Circulation.

i. Nerves.

2. Abdomen.

3. Fibrous tissues.

4. Organs.

From the Melanthaceae we obtain the following medicines : Veratrum album, Veratrum viride, Sabadilla, and Colchicum. Of these drugs, I may say that I am pretty well persuaded that the Veratrum album and Veratrum viride are well understood, and are, therefore, not easily misapplied. I am also well persuaded that Colchicum has not the place in practice it deserves. True, it comes to us from the allopathic school as a remedy highly recommended for gout. We ought not, however, from the exorbitant use of the drug by that school, to go to the opposite extreme, and neglect it altogether as a remedy.

Colchicum.

The symptoms of Colchicum I have arranged under four headings. The first, the nerves, includes typhoid conditions and debility. You must know that the drug tends to produce great prostration, and from this arises the great danger in administering it in large doses as a routine remedy in gout and rheumatism. While the paroxysms of pain may be relieved thereby, there is apt to be induced a condition of debility which runs the patient into other and new dangers. Let us see how we can use this effect of the drug under our law of cure. We find it indicated in debility, particularly in debility following loss of sleep ; for instance, when one does not retire as early as usual in the evening, so that he is deprived of a portion of his accustomed sleep, he awakens next morning feeling tired and languid ; he can hardly drag one leg after the other ; the appetite is gone ; bad taste in the mouth and nausea are present. The debility, then, starts from or involves digestion as a result of loss of sleep. You can see how close this comes to the Nux vomica condition. The debility, however, is greater even than that of Nux vomica. There is, at times, an aversion to all food ; the odor of food cooking makes the patient feel sick ; he becomes irritable ; every little external impression annoys him ; here it is precisely like Nux vomica.

As another form of debility or debilitating fever, we find Colchicum indicated at times in typhoid fever. Now, the position of Colchicum in typhoid fever is between Arsenicum and Cinchona. First, we find that the patient's intellect is beclouded. But although his mind is befogged, he still answers your questions correctly, showing you that he is not in a complete stupor. Unless questioned concerning it, he says nothing about his condition, which does not seem dangerous to him. There is not that fearfulness, that dread of death, which characterizes some other drugs indicated in typhoid fevers. The pupils are widely dilated, and very imperfectly sensitive to light. There is a cold sweat on the forehead ; here you will at once note a resemblance to Veratrum album. When the patient attempts to raise the head from the pillow, it falls back again and the mouth opens wide. You thus see how weak are the muscles in the Colchicum case. The face has a cadaverous appearance. The features are sharp and pointed, the nose looks as though it had been pinched or tightly squeezed, and the nostrils are dry and even black. The tongue is heavy and stiff, and is protruded with difficulty. In extreme cases it is bluish, particularly at the base. There is almost complete loss of speech, and the breath is cold. There are often nausea and vomiting, the latter being attended with considerable retching. These symptoms are associated with restlessness and cramps in the legs. The body is hot while the extremities are cold. Coming to the abdominal region, we find tympanites is exceedingly well marked. Stools are watery and frequent, and escape involuntarily. These are the symptoms which lead you to Colchicum in typhoid states. They greatly resemble those calling for Arsenicum and Cinchona. They resemble Arsenicum in the intensity of the debility and Cinchona in the tympanitic condition. Colchicum seems to stand between the two, combining the restlessness and debility of Arsenic with the tympany of Cinchona. You will notice that the Colchicum symptoms are principally abdominal. Some of them suggest Veratrum album. You must, therefore, place this remedy in your mind by the side of Colchicum, that you may make the necessary distinction between the two.

Carbo vegetabilis is allied to Colchicum in the coldness of the breath, in the tympany, and in the great prostration. But Carbo veg. seems to suit when there is giving out of the vital forces. The patient lies cold and almost pulseless. The pulse feels much like a slight ripple beneath the examining finger ; there is no decided pulsation. The feet and the legs below the knees are cold, or there may be coldness of the knees and feet, the parts between them not being cold. A watery stool is not so characteristic of Carbo veg., the discharges being either absent or, if present, dark brown and horribly offensive. Next we come to the abdominal symptoms. The tympany and the diarrhoea have already been mentioned. In addition to these symptoms we have others which strongly point to the drug as a possible remedy in cholera. There are nausea and vomiting, the nausea seeming to be provoked by the smell of food. Whenever the patient sits up, the nausea and vomiting become worse. The matters vomited are watery and bilious. When dysenteric symptoms are present, the stools are frequent, watery and blood} , and contain shreds which were formed}- 7 supposed to be portions of the lining membrane of the bowels, but which are now known to be a plastic formation from exudation. Tenesmus is violent, and is followed by spasm of the sphincter ani. If you have a case of dysentery with these symptoms, Colchicum will help you out. If there is tympany also, all the more is it indicated, being then far preferable to Cantharis, Mercurius or any other remedy in our materia medica.

The third heading on the board is " Fibrous tissues." This brings us to the consideration of Colchicum in rheumatism and gout. Now, Colchicum has a special affinity for the fibrous tissues. I include under this term the tendons and aponeuroses of muscles, ligaments of joints and even the periosteum. The swelling produced by it is either dark red or pale in color, with no particular tendency to suppuration, extremely sensitive to touch, and with a strong tendency to shift from joint to joint. In rheumatism proper, Colchicum is indicated when it begins in one joint and travels thence to another, or in one side of the body and then flies to the other. The pains are worse in the evening. The joint is extremely sensitive to the slightest motion. The urine is dark red and scanty, just such as you would expect to find in gout or rheumatism. You will find such patients exceedingly irritable. Every little external impression, as light, noise or strong odors, annoys them, and pain seems to be unbearable. The only difference between these symptoms and those of gout is that in the latter the great-toe is involved, and the paroxysms occur in the night.

Sometimes we have metastasis of rheumatism or gout to the chest. Even then Colchicum may be the remedy. In valvular heart disease or pericarditis following rheumatism, it is indicated by violent cutting and stinging pains in the chest, particularly about the heart, with great oppression and dyspnoea. There is also the sensation as if the chest were being squeezed by a tight bandage. Colchicum stands almost alone in gout and rheumatism. There are no remedies similar to it in action here.

Colchicum is sometimes indicated in dropsy with suppression of urine. The dropsy is particularly liable to appear as hydrothorax. What urine does pass contains blood, and is almost as black as ink, and is loaded with albumen. Hence you see that it is indicated in dropsy depending upon Bright' s disease. Here it resembles, quite closely, Lachesis, which also has this black urine.

It also resembles Terebinthina, which causes congestion of the kidneys with rupture of the fine capillaries, and consequent pouring out of blood into the pelvis of the kidneys. The urine contains tube-casts. It is smoky in appearance, and has a dirty pinkish deposit. Thus you have seen when Colchicum may be used in rheumatism, when in typhoid fever, and when in simple debility. The fact that the protracted use of Colchicu?n is followed by great prostration will lead you to study the drug, when after frequent acute attacks of gout the patient becomes greatly weakened.

In affections of the heart Colchicum is closely allied to Spigelia. When Colchicum has been abused, Spigelia is the remedy to be used ' as an antidote.