Colocynthis

Acts on digestive tract, then longer on spinal nerves. SUDDEN, ATROCIOUS CRAMPINGS, gripings, tearings, etc., making him TWIST, turn or cry out in pain; with nausea or diuresis. Convulsive jerks or constrictions during pain (Ign. Lyc.). Lightning-like pains. CUTTING, pinching, clamping, gnawing or boring pain; then numbness. Parts seem too short. Constriction. Neuralgia. .................... Anger; easily vexed; < pains. Tearing head pains, < moving eyelids. Faceache (l); with eye symptoms or alternating with cœlialgia. Distorted face. Persistent bitter taste. Gas colic (flatulent colic). WAVES OF VIOLENT CUTTING, GRIPING, GRASPING, CLUTCHING OR RADIATING ABDOMINAL COLIC DOUBLE HIM UP; > HARD PRESSURE; < least food. Cutting in bowels; at navel. Pressure > at first then <. Intestines feel squeezed between stones. Pains alternating between ovaries. Ovaralgia. Vomits from pain. Yellow, frothy, watery, shreddy, sourish or gelatinous stools; with colic and gas. Dysentery. Slippery bubbles escape from anus. Gelatinous, sticky or stringy urine. Heart feels pushed up by a distended stomach. Pain under r. scapula, > pressure (Bry.). Lumbar ache, > pressure. Cramps in hips. Screwing, band-like or shooting sciatic pains; < least motion, rotation or night, > lying on painful part. Limbs drawn up like a hedgehog. Urinous sweat.

EMOTIONS. VEXATION. Chagrin. Anger. Lying on painless side. Night, in bed. Drafts. Taking cold.

HARD PRESSURE. Coffee. Heat. Rest. Gentle motion. After stool or flatus.

NERVES (large): TRIFACIAL. ABDOMINAL. Spinal. SCIATIC. DIGESTIVE TRACT (NAVEL). INTESTINES. Ovaries. Kidneys. Left side.

Complementary: Caus. Antidote: Op. Related: Stap.

Colocynthis

Squirting Cucumber. CucurhitacccE.

Agonizing pain in abdomen causing patient to bend double, with restlessness, twisting and turning to obtain relief; > by hard pressure (> by heat, Mag. p.).

Pains: are worse after eating. or drinking; compel patient to bend double (Mag. p. — < by bending double, Dios.) ; menses, suppressed by chagrin, colic pains.

Extremely irritable, impatient ; becomes angry or offended on being questioned.

Irritable; throws things out of his hands.

vomiting, diarrhoea and suppression of menses (Cham., Staph.).

Vertigo: when quickly turning head, especially to the left, as if he would fall; from stimulants.

Sciatica: crampy pain in hip, as though screwed in a vise; lies upon affected side.

Shooting pain, like lightning-shocks, down the whole limb, left hip, left thigh, left knee, into popliteal fossa.

with great tenesmus.

Compare : Gnaph. intense pain along right sciatic nerve, darting, cutting, from right hip joint down to foot; < lying down, motion, stepping; > by sitting.

Compare with Staph, in ovarian or other diseases from bad effects of anger, reserved indignation or silent grief.

Aggravation. — Anger and indignation; mortification caused by offense (Staph., Lyc.) ; cheese < colic.

Amelioration. — From doubling up; hard pressure.

Lecture XXVIII — Cucurbitaceae — Colocynth

CUCURBITACEiE.

i . Colocynthis cucumis.

2. Bryonia alba.

3. Citrullus (Water-melon). The seeds are Cucurbitaceae. 1 diuretic.

4. Cucurbita (Squash).

5. Momordica balsamina.—Flatulency.

6. Blaterium momordica.—Bowels and fever.

To-day we begin our study of the Cucurbitaceae. This order gives us some six or eight drugs, and also some edible fruits. Among the latter are the water-melon, canteloupe, and cucumber. The seeds of some of these have diuretic properties, and those of the water-melon, pumpkin and squash have been used as a cure for worms.

Of the medicinal substances obtained from this order we may say that they all act prominently on the alimentary tract. They seem to have in common a cathartic action. They probably act paralyzingly on the vaso-motor nerves of the abdomen. They produce griping pains, gushing watery diarrhoea. This last symptom is most prominent under Elaterium.

Let us now enumerate these medicines. Fifth on the list is the Momordica balsamina ; of this we have but one characteristic symptom, and that is accumulation of flatus in the splenic flexure of the colon, precisely like Lycopodium. It is a very convenient thing to know this. For instance, if, during the course of a more or less chronic disease, this one symptom becomes very annoying, and you do not want to destroy the action of the drug you are giving, you simply interpolate a dose of Momordica, which removes the symptom and enables you to go on with the treatment as before.

Elaterium, another member of the order, has been used principally, in our school of medicine, in a peculiar form of diarrhoea. Like all the CucurbitacecE, it acts powerfully on the alimentary tract, producing a sudden and enormous effusion of serum into the bowels. Thus it causes a watery diarrhoea, the stools flowing out very profusely. The characteristic symptom of the drug, and the one which will lead you to its selection in cholera infantum, is watery stools of an olive-green color, coming out with a gush, with cutting pains in the abdomen. Thus, you see, it is comparable with Croton tiglium, Podophyllum, Veratrum album, and remedies of that type.

It is readily distinguished from Croton tiglium, which is adapted to a profuse, yellow, watery stool, which is provoked every time the patient eats and drinks.

Podophyllum has, as you all know, the morning aggravation to distinguish it.

The remaining medicines belonging to the Cucurbitaceae are the Citrullus, or water-melon ; the Cucurbita, or squash, the seeds of which, as well as those of the pumpkin, have been used for taenia ; the Colocynth, and the Bryonia alba; the last two being drugs of great importance, we shall proceed to their consideration in extenso. COLOCYNTHIS CUCUMIS.

Neuralgia.

1. Nerves.

Cramp.

Colocynthis. \ 2. Bowels.

3. Urine.

[4. Gout.

The Colocynthis cucumis furnishes us with a gourd about the size of an orange with a smooth marbled green surface. When dried it appears of a brownish color. It is not indigenous to this country, but is imported from Syria and Turkey. Often, however, it is found in the market, peeled and dried, looking like a pithy ball, full of seeds and very light in weight. It is inodorous, but it has an intensely bitter taste.

Like the other members of this group, Colocynth causes violent intestinal irritation, first of watery evacuations and later of mucus and blood. The pains are atrocious; griping, cutting, etc. But this is not all. The drug also affects the nervous system powerfully, whence comes its beneficial effects in the treatment of various neuralgias. (In its neurotic symptoms, Colocynth is closely allied to Dioscorea villosa). Furthermore, this remedy so long restricted to the relief of colic alone, has lately wrought cures in certain deep-seated ovarian diseases, as ovarian tumors. Colocy?ilh acts directly on the ovaries, and also upon the epididymis. It is a mistake to assert, as was done formerly, that it can cause no inflammatory action ; for in a case of poisoning, the autopsy revealed freshly-glued intestines, thus showing an inflammatory exudate. It is indicated in affections of the ovaries by stitching pains as from a needle deep in the right ovarian region, and crampy pains relieved by bending over or from pressure.

Two cases of ovarian tumor have been reported as cured by Colocynth on these symptoms.

I remember having cured a lady of ovarian colic from which she had suffered for three years, with Colocynth. The pains in this case were of a griping character and were relieved by bending double. There were no organic changes present.

Now let us examine the action of Colocynth on the abdomen and its contents with the concomitant symptoms : persistent bitter taste ; violent thirst ; empty eructations ; nausea ; vomiting of a bitter fluid or of food ; griping pains which force him to bend double or to press firmly against the abdomen. This griping is the well-known key-note of the drug, and it is indicatory whether it be of local origin or reflex, whether arising from flatus, undigested food, or cold ; or whether resulting from violent emotions, as in what has been termed li nervous colic." The stools may be fluid, copious, faecal, flatulent and papescent ; or slimy and bloody and preceded by severe tenesmus ; but in every case there is this griping which more often precedes the stool and is relieved afterward, although sometimes it continues after stool. These evacuations are provoked by the slightest food or drink, as is also the pain. In some instances the griping develops into cutting, stabbing pains, which spread all over the abdomen and down into the pelvis. They are relieved by the emission of flatus or by stool. The pressure of flatus may incommode the bladder, relief, however, instantly following borborygmi. The urine is foetid and deposits a mucous sediment.

We shall now compare Colocynth with some of its concordant remedies.

In the bad effects of anger, Colocynth is closely allied to Chamomilla and Staphisagria, and more remotely, to Causticum. It resembles Chamomilla in the violence of its emotions. Both drugs may be used in children when violent emotions produce cramps and even bilious stools. Chamomilla differs from Colocynth in the violence of its congestive symptoms, hot sweat on the head, etc. The characteristic Chamomilla temperament also helps you to decide.

Staphisagria is sometimes to be substituted for Colocynth in the effects of violent emotion in women and children when the violent abdominal cramps fail to yield to the latter remedy.

In its abdominal and gastro-enteric symptoms you should compare it with Aconite, Veratrum album, Bovista, Croton tiglium, Elaterium, and Mercurius.

Veratrum album has abdominal pains forcing the patient to bend double, but he must walk about for relief. He also has cold sweat on the forehead. It is especially suitable in ileus or intussusception of the bowels.

The colic of Bovista finds relief from bending double and after eating. The urine is red.

Croton tiglium has griping pains with profuse watery diarrhoea. The stools are yellowish, brownish or green ir^ color and profuse, coming out with a gush, like water from a hydrant. They are aggravated after nursing or eating.

As shown by the symptoms, Colocynth is a remedy sometimes needed in summer complaint and in dysentery. It differs from Croton tiglium, which has stools whenever the patient eats or drinks, in that the latter has movements which are profuse and watery, and gushing like water from a hydrant. Elaterium again changes the picture by producing olive-green stools, profuse and gushing. Croton tig., it is true, causes green stools, but they are a brownish green.

Colocynth differs from Mercurius because in the former the tenesmus, etc., cease after stool. It differs from Nux vomica also, for although the pain ceases after stool in Nux, the movements are scanty and there is frequent ineffectual urging.

The griping already referred to is not, in Colocynth, confined to the intestinal tract. We may confidently employ the remedy when the griping involves the bladder in some forms of strangury or of spasm of that viscus, and also in menstrual colic, whether uterine or ovarian. All that is requisite is that the nervous element should predominate over the inflammatory, with the relief from bending double and from firm external pressure.

Transferring this action of the drug upon the sympathetic to the " voluntary system," or cerebro-spinal system, we find symptoms like the following : left-sided tearing crampy pains after vexation or mortified feelings ; boring, tearing pains in the head, boring stitches, sharp cutting pains in the eyeballs and extending thence up into the head ; worse at rest and on stooping, and better from firm pressure and from walking ; eye, on stooping, feels as if it would fall out ; profuse acrid tears. These symptoms suggest Colocynth as a remedy in gouty and bilious headaches, and also in the intense pains of iritis, ciliary neuralgia and glaucoma.

Here we may compare Chamomilla, Cedron, Spigelia and Prunus spinosa.

Chamomilla also has left-sided tearing headache from anger, biliousness, etc., but it has more red face, hot sweat, etc.

Cedron has periodical pains about the eyes ; it is usually, however, supra-orbital, and it may be of malarial origin.

Spigelia is very similar to Colocynth. The eye feels too large ; the pains are stabbing, tearing and radiating ; they are aggravated by pressure and motion ; Colocynth rinding relief by walking in a warm room, and on pressure.

Prunus spinosa has more crushing pain ; a feeling as if the parts were pressed asunder, or violent bursting pain shooting back to the occiput. Colocynth has proved useful in hip-disease, especially of the right side ; dull stitches during walking, must stand still ; followed by heaviness and insensibility of the affected parts; crampy pain as though the parts were screwed in a vise : lies on the affected side with the knee drawn up.

In studying these symptoms we also see the application of the drug to sciatica ; pains extending down the sciatic nerve to the knee or even to the heel, aggravated by any motion. The attacks of pain are followed by numbness of the whole limb and partial paralysis. If the case is of long continuance, the nutrition of the limb is deficient. Sometimes the cramps in the leg are so severe that the patient feels as if the whole leg were fastened down by iron bands. The pains are usually worse at night.

Gnaphalium is very similar to Colocynth in sciatica. It has intense neuralgic pains along the course of the sciatic nerve, alternating with numbness.

In cramps of the muscles you should compare Colocynth, Nux vomica, Veratrum album and Cholos terrapince. I know of no remedy better adapted to simple cramps in the muscles than the last named in this list.

In rheumatism, Colocynth may be useful, especially for the stiffness of the joints following the acute disease.

If, however, there are concretions in the joints, you should think of Causticum and Guaiacum.

Guided by its constrictive qualities, physicians have used Colocynth in paraphimosis.

Colocynth is antidoted by Coffee, Camphor and Staphisagria.

Extremely irritable. Becomes angry when questioned. Mortification caused by offense. Anger, with indignation (Cham; Bry; Nux).

Bitter Cucumber Often indicated in the transition season when the air is cold, but the sun is still powerful enough to heat the blood. Develops most of its symptoms in the abdomen and head, causing intense neuralgias. It is especially suitable for irritable persons easily angered, and ill effects therefrom. Women with copious menstruation, and of sedentary habits. Persons with a tendency to corpulency. The neuralgic pains are nearly always relieved by pressure. Cramps and twitching and shortening of muscles. Constrictions and contractions. Cystospasm following operations on orifices

(Hyper). Urinous odor of perspiration (Berb; Nitr ac). Agonizing pain in abdomen, causing patient to bend double, is most characteristic. Sensations; cutting, twisting, grinding, contracting and bruised; as if clamped with iron bands.

Worse, from anger and indignation. Better, doubling up, hard pressure, warmth, lying with head bent forward.

Vertigo when turning head to the left. Lateral cutting headache, with nausea, vomiting. Pains (better pressure and heat), with soreness of scalp. Burning pains, digging, rending, and tearing. Frontal headache; worse, stooping, lying on back, and moving eyelids.

Tearing, shooting, and swelling of face; left side great soreness. Get relief from pressure (China). Neuralgia, with chilliness; teeth seem too long. Sounds re- echo in ears. Pain in stomach, always with pain of teeth or head.

Pains sharp, boring, better pressure. Sensation on stooping, as if eye would fall out. Gouty affections of eyes. Violent pain in eyeballs which precede the development of glaucoma.

Very bitter taste. Tongue rough, as from sand, and feels scalded. Canine hunger. Feeling in stomach as if something would not yield; drawing pain.

Agonizing cutting pain in abdomen causing patient to end over double, and pressing on the abdomen. Sensation as if stones were being ground together in the abdomen, and would burst. Intestines feel as if bruised. Colic with cramps in calves. Cutting in abdomen, especially after anger. Each paroxysm is attended with general agitation and a chill over the cheeks, ascending from the hypogastrium. Pain in small spot below navel. Dysenteric stool renewed each time by the least food or drink. Jelly-like stools. Musty odor. Distention.

Intense burning along urethra during stool. Vesical catarrh, discharge like fresh white of egg. Viscid (Phos acid) fetid; small quantities, with frequent urging. Itching at orifice. Red, hard crystals, adhering firmly to vessel. Tenesmus of bladder. Pains on urinating over whole abdomen.

Boring pain in ovary. Must draw up double, with great restlessness. Round, small cystic tumors in ovaries or broad ligaments. Wants abdomen supported by pressure. Bearing-down cramps, causing her to bend double (Opium).

Contraction of muscles. All the limbs are drawn together. Pain in right deltoid (Guaco). Cramp-like pain in hip; lies on affected side; pain from hip to knee. Spontaneous luxation of the hip-joints. Stiffness of joints and shortening of tendons. Sciatic pain, left side, drawing, tearing; better, pressure and heat; worse, gentle touch. Contraction of the muscles. Pain down right thigh; muscles

and tendons feel too short; numbness with pains (Gnaphal). Pain in left knee joint.

Antidote: Coffea; Staphis; Cham. Colocynth is the best antidote to lead poisoning (Royal). Compare: Lobelia erinus (violent cork-screw-like pains in abdomen). Dipodium punctatum (Writhing. Twisting like a dying snake. Intractable insomnia). Dioscor; Chamom; Coccul; Merc; Plum; Magn phos.

Sixth to thirtieth potency.

Colocynthis

Pains: The principal feature of Colocynth is its severe, tearing, neuralgic pains; so severe that the patient is unable to keep still. Sometimes they are > by motion - at least it appears that they are worse during rest- > by pressure and sometimes > by heat. Pains occur in the face, abdomen, along the course of the nerves. These pains are often due to a very singular cause, namely, anger with indignation. Hence persons who are haughty and easily offended or chagrined have Colocynth complaints. Anger will be followed by violent neuralgia in the head, eyes, down the spine and in the intestines. In spite of extreme restlessness there is great weakness with the pains. It patient suffering with chronic diarrhoea, with severe colic, will sometimes become so weak that he can hardly speak. A feeling of faintness, or even fainting, is by no means an unusual concomitant of the pains. Griping occurs along the course of nerves, and in some cases numbness, pricking and tingling, like the crawling of ants in the part affected.

With many doctors Colocynth is a routine remedy for sciatica; and only when it fails to do they take the symptoms of the case in order to find the remedy that is indicated. There is no excuse for such practice. Where the pain is better from hard pressure and from heat, where it is worse during repose and drives the patient to despair, Colocynth will generally cure.

But it is not indicated in all cases. Some remedies select the muscles and tendons, some the bones and periosteum, while others select the great nerve trunks in which to manifest their symptoms. The pains of Colocynth appear, as a rule, in the larger nerves.

The mental symptoms are not very striking. As soon as the prover of Colocynth begins to have pains a long the course of nerves he becomes irritable; everything vexes him; he is worse from vexation.

Screams with the pains. Walks about the room and becomes increasingly anxious as the pain goes on. Disinclined to talk or to answer, or to see friends. His friends irritate him and he wants to be alone. He has all he can do to stand those terrible pains.

Vomiting and diarrhea frequently come with the pains, especially if they are in the abdomen. Colic comes on in paroxysms that grow in intensity. The patient becomes increasingly nauseated until finally he vomits and he continues to retch after the stomach is empty. Colocynth produces a state in the nervous system like that found in individuals who have for years been laboring under annoyances and vexations. A man whose business affairs have been going wrong becomes irritable and nervous exhaustion follows.

A woman who must watch her unfaithful husband night and day to keep him away from other women gradually assumes a sensitive irritable state of mind and is upset by the least provocation. This is the state of the Colocynth prover.

You will seldom find this medicine indicated in strong, vigorous, healthy people who have suddenly become sick. It is more likely to be in the constitution just described, and those who are in the habit of overeating.

We find tearing pains in the scalp, brought on by anger; exhaustion, pains that are better from pressure and heat, and worse when not in motion. Constant, gnawing pains in the head.

Head: Painful, tearing, digging through the whole brain, becoming unbearable when moving the eyelids. Intense pain through the whole head; worse from moving the eyes. Severe, pressing, tearing headache, causing her to cry out. Intermittent headache in those of a rheumatic, gouty or nervous diathesis. Pain tearing and screwing together. Violent periodical or intermittent headache.

Such are some of the expressions in the text. But the particular character of the pain is not as important as the circumstances that are likely to cause it and the conditions in which the patient has been living.

Eyes: Knowing the life of a patient affords much knowledge of the patient himself. The same violent neuralgic pains are found in the eye. Rheumatic iritis, worse in the evening and night. Severe, burning, cutting and sticking pains in the eye. Burning is more characteristic of the pains of the eyes than of other parts of the head and face. Sharp, cutting- stabs; pressing pains.

Face: The faceache is especially important, because Colocynth is one of the most frequently indicated remedies for neuralgia of this region. There are some remedies which are indicated in faceache more often than any others, Belladonna, Magnesia phosphorica and Colocynth.

The Belladonna pains are as violent as any, and are accompanied by red face, flashing eyes, hot head, and great sensitiveness of the part to touch.

In Colocynth the pains come in waves, are better from heat, from pressure, worse if anything during rest, and are brought on by excitement or vexation.

They are generally on the left side; while those of Belladonna are on the right, and are caused by cold.

Magnesia phosphorica has tearing and pains that shoot like lightning along the nerves and are relieved by heat and pressure.

The expression of the Colocynth face is one of anxiety from the severity of the suffering. No matter where the pain is the face is distorted. Finally, it becomes pale and the cheeks become blue.

Tearing pains in the cheek-bones, or more correctly, in the infra orbital nerve where it emerges from the foramen. Sometimes this pain feels like a hot wire, sometimes like a cold nail, and sometimes it is tearing, burning or stinging. Frequently it spreads over the face, following the ramifications of the small branches of the nerve, usually on the left side. The patient cries out and is very restless. Tearing or burning pain extending to the ear and head.

All pains are better from pressure, but this is in the beginning. After the pain has been going for several days with increasing severity, the part becomes very sensitive and pressure cannot be endured.

Stomach: Aversion to food. Violent thirst. Colic brought on from drinking while overheated; from eating indigestible things, from high living; colic from eating potatoes.

Potatoes and starchy foods disagree with the Colocynth patient like Alumina. The vomiting of Colocynth is different from that of most other remedies .

Nausea does not appear at first, but when the pain becomes sufficiently intense nausea and vomiting begin, the contents of the stomach are ejected and the patient continues to retch until the severity of the suffering decreases. The stomach pains are clutching, cramping and digging; as if grasped by the fingers.

Abdomen: Similar pains occur lower down in the abdomen, but they are still better from hard pressure, and from doubling up which amounts to pressure, come on in paroxysms of increasing severity, until the patient is nauseated and vomits, and are associated with great restlessness and faint, sinking feeling at the pit of the stomach.

The victim, bends down over the back of a chair, or over the foot-board if unable to get out of bed.

In the Guiding Symptoms we find several pages of repetitions, showing how extensively this medicine is applicable in abdominal complaints where these symptoms are present. It would be well to read them.

The pains in the lower part of the abdomen are relieved by drawing up the limbs and pressing with the fists. In the violent ovarian neuralgias of Colocynth, the woman will flex the limb of the painful side hard against the abdomen and hold it there.

The physician asks:

"What has happened to give you these pains? Her answer is likely to be:

"My servant spilled some dirty water on a handsome rug, we had some words over it, and this is the result. "

Colic from anger with indignation; better from bending double and worse in the upright position, while standing or bending backwards. Colic of infants when they are relieved by lying on the stomach as soon as the position is changed they begin to scream again, The same symptoms accompanying the diarrhoea and dysentery, The stools consists of white mucus, are thick, ropy and jelly-like; at times bloody.

At first they may be copious, strong smelling, pappy, and later watery, yellow, scanty and almost inodorous.

Diarrhoea and dysentery from anger with indignation; the most awful tenesmus during stool; urging to stool with colic. Eating ever so little, rings on the colic, urging and stool. Watery stools after eating. Many of these cases, find relief from heat and the warmth of the bed.