Colchicum autumnale. N.O. Melanthaceae. A tincture from corn or seeds.
THE gross effect of large and massive doses of colchicum may be summed up in one phrase-it is a violent gastrointestinal irritant. At its mildest, in medicinal doses it causes an increased flow of bile with some nausea, diarrhoea and colic. In full doses it causes vomiting, great abdominal pain, severe watery purging with blood in the motions, and tenesmus; in massive doses rapid prostration ensues, with rapid, thready pulse, pale, cold skin and cold sweat, slow, shallow respiration, and death from collapse-the reflex effect of severe gastroenteritis. These results occur even if the drug is administered subcutaneously. Consciousness is not affected, but sensation respiratory paralysis. The polynuclear leucocytes are first collected in the marrow and tissues, but later they are greatly increased in the blood. Prolonged muscle contraction occurs,like that met with in Thomson’s disease (myotonia congenita).
Colchicum does not materially alter the constituents of the urine when given in ordinary doses, therefore its beneficial action is not due to increased elimination of uric acid, the amount of which in the urine remains unchanged (Cushny, eighth edition, p. 482).
The doses producing the above symptoms veil the finer effects as experienced by provers, of which the following is a summary. In this account, however, clinical symptoms are included, as they are inseparable from the pure effects.
Digestive Organs.-The smell of food, especially of cooking fish causes nausea and even faintness; this occurs even from the smell of things for which the prover craved. Vomiting may ensue- of bile or mucus; it is worse from any movement, and is accompanied with great (icy) coldness in the stomach and abdomen. There is some distension, and in the case of some poisoned animals immense and fatal tympanites has occurred.
The coldness referred to may alternate with or be replaced by burning. Gastralgia, pain in the caecum and colon, and over the liver, are among the results, together with much rumbling of flatulence in the bowels and relief from passing wind. Dysenteric symptoms are induced pain and straining during evacuation, the stools are jelly-like and contain exfoliated mucous membrane and not seldom blood. The anus feels as if torn, and tends of prolapse after considerable straining.
Urinary System.-The urine is dark and scanty or suppressed, and may contain blood, albumin and sugar,but the source of these elements is not clear. Its passage may be accompanied by burning straining; involuntary escape of urine when coughing. It is not proved that there is any increase in the area and uric acid excreted.
Circulation.-The thread-like pulse of approaching collapse has been alluded to. The heart sounds are weak, and blood- pressure is low. Pericarditis and pleuritis-possibly secondary to the gastro-enteritis-are reported, accompanied by severe precordial pain, oppression and dyspnoea. A feeling as if the chest were bound by a tight bandage may be experienced, worse lying on the left side.
Head.-Pain in the temples and forehead is felt, also in the nape of the neck; it is worse in the afternoon and evening, on stooping, and from mental exertion. Unilateral headache, from orbit to occiput, may cause delirium (compare spigelia, thuja, and sepia for left-sided pain, and bell. and silica for right_. The scalp is sensitive to touch, and the head feels as if bursting, and yet constricted by tight covering. The pupils are unequal; vision is dim after the strain of reading; lachrymation and tearing pain are present-worse in the open air. It is said that opacity of the lens has been caused in poisoning cases.
Extremities.-The effects experienced in the limbs after small doses are veiled by massive ones. By provers, sharp pains have been felt down the left arm, pins and needles in the hands, wrists and fingers, and tingling under the finger nails, which prevent objects being held firmly. Warm weather brings on tearing pain, and cold induces stinging. Then lower limbs are lame and weak, and the joints feel stiff. Cramps and oedema are induced. Inflammation in the big toe and heel, with great tenderness to touch, are said to be caused by colchicum. The pains are worse at night, in cold, damp weather, and in the extreme heat of summer- either extreme; and they are liable to be accompanied by acid perspiration.
Back.-Pains in the nape of the neck and chest, in the loins and sacral region, are worse from movement and relieved by pressure.
Skin.-A papular rash appears on the face, and erythematous or urticarious spots come out in different places, but nothing like definite eczema. Tingling of skin, as when recovering from frost bite, and copious sour sweats come and go in different sites.
In substantial doses “orthodoxy” uses colchicum for “gout,” and there is no doubt of its palliative value. Its use is empirical, for candid authorities admit that its mode of action is unknown. Assuming that the joint symptoms recorded above are genuine pathogenetic effects the explanation must be a homoeopathic one and the ordinary dose must be unnecessarily large. Neither of these assumptions, however, is fully substantiated. The indications for its use in gouty conditions must be taken as clinical.
Gout and Rheumatism.-The affected parts are very sensitive to touch and movement, especially sudden, jarring movement. The patient is worse during warm weather, and at any time he is extremely sensitive to pain-his “sufferings seem intolerable.” Pain tend to travel from left to right (like those of lachesis). Superficial pains are worse during warm weather, and deep ones when it is cold.
Neuralgia.-The neuralgia of gouty or other patients with the above characteristics will be benefited by colchicum, whether the pains be in the head or the eyes, the intercostal nerves or the face. Patients for whom the drug is required resemble those of a chamomilla type, in being highly sensitive to all impressions, physical and mental-to touch (as stated), to noise, to light and especially to odours-the smell of cooking food (especially fish) inducing nausea and even faintness. There is aversion from all food.
The muscular affections brought on by the drug have caused it to be used in torticollis and lumbago.
A patient with these characteristics will certainly benefit by colchicum, whether his malady belong to the foregoing class- gouty and rheumatic-or to the next class-the dysenteric. To dysentery, colchicum poisoning shows a very striking resemblance- the kind of alvine discharges have been mentioned, but it is the type of patient just described for whom the drug will be beneficial. Old people of vigorous constitution and of a gouty diathesis may require it, but it is more frequently indicated in asthenic cases (of gout, &c.,) where the patient is worn down by long and painful attacks.
Simple acute diarrhoea with nausea at the thought or smell of food, and with borborygmi, have been cured by the drug.
Some of the colchicum poisonings closely counterfeit the collapse stage of cholera, and it has been used for that serious complaint with success.
The great abdominal distension, with prostration, pallor and rapid pulse, recalls of septic peritonitis, and in so far as medicine claims a place in the treatment of these serious cases colchicum would have to be considered. It has also been recommended in enteric fever, with prostration and much distension-even after perforation. In any of these intestinal conditions deadly nausea and severe prostration are confirmatory indications.
The ocular symptoms are a little indefinite, but they have led to the use of colchicum, with reported benefit in a few cases of soft cataract and in rheumatic iritis.
(1) General over-sensitiveness to impressions, physical and mental; great sensitiveness to smells is very notable, inducing nausea and faintness.
(2) Great exhaustion, trembling and deadly nausea (intestinal cases), asthenic cases (gouty patients).
(3) Irritability and peevishness; nothing satisfies.
(4) Nocturnal aggravation (fever, chest, cough, pains).
(5) Migration of pains from one joint to another.
(6) Relief from warmth, wrapping parts up.
(7) Named diseases in which colchicum may be useful:-
(a) Intestinal conditions.-Dysentery, diarrhoea cholera, enteric fever, gastralgia (ascites)?
(b) Joints and muscles, gouty and rheumatic conditions; torticollis.
(c) Chest, pericarditis, pleurisy.
From movement, the patient dreads to move, and from touch-except steady pressure, which restrains movement (limbs and abdomen); from stooping (head), from mental exertion; from sitting up in bed (cardiac); from cold, damp weather, and great heat in summer-either extreme; from odour of cooking food; at night.