Having now studied the properties and uses of Bryonia, Aconite and Rhus, remedies which, in addition to their applicability in fevers and various other affections, are eminently adapted to the treatment of the general class of maladies grouped under the name of rheumatism, it seems to me most fitting to study now certain other drugs which are eminently anti-rheumatics, before proceeding to other groups of which the characteristic symptoms indicate a different variety of action upon different organs and tissues. These drugs are Colchicum, Ledum, Rhododendron, Kalmia, and Spigelia.
The autumn crocus, or meadow-saffron, is a beautiful flower, found in most parts of temperate Europe, and especially abundant and beautiful near the site of the ancient Alba Longa, not far from Rome. The parts used are the root and the seeds, and various opinions have been expressed by different authors respecting the relative activity of these portions of the plant. The majority of the provings made by homeopaths were made with a tincture of the freshly gathered root. Colchicum was well known to the ancients, as indeed its name implies (from the island Colchos, where it abounded), and very little has been added, even in our day, to the knowledge which the ancients possessed of its properties and uses. It was described by them as a violent emeto-cathartic, and on that account a dangerous remedy; as, however, a specific remedy for gout and rheumatism, in which it gave magical relief. They considered its frequent and continued use in gout to be injurious, because of its action on the stomach and bowels, and Alexander of Tralles, in the fifth century, says that although it does speedily relieve the pain and soreness of an attack of gout, it nevertheless favors the frequent recurrence of these attacks,—an opinion which is repeated by Mr. Barwell, the most recent authority on " Diseases of the Joints." (London, i860.)
In general, the effects ascribed to Colchicum are the following: in large doses it produces loss of muscular power, slow breathing, and slow and feeble pulse. The sensorium is but little disturbed.
Upon the digestive organs it acts with great energy, increasing and altering the secretion from some or all of their mucous surfaces. Sometimes profuse salivation results. More frequently, profuse secretion of urine. But most frequently of all, nausea, eructations and copious vomiting of mucus and bile with frequent and abundant alvine evacuations, consisting of watery matters with white, skinny flocculi, or of yellowish and bloody matter. There is much tenesmus. The flatulent distention of the abdomen is sometimes enormous; when this is the case the stools are not so frequent nor so copious. Perfect loathing of food,—a symptom which led Dr. Hawley to give Colchicum successfully in an intermittent.
This action upon the intestines is observed not merely when the Colchicum is taken into the stomach, but also when it is injected into a vein or rubbed upon the external skin of the abdomen.
In addition to the above symptoms, the nervous system has been observed to be affected as follows : "Numbness of the hands and feet, with prickling as if they were asleep; painful flexure of the joints; pain in the shoulder and hip joints and in all the bones, with difficulty of moving the head and tongue." (Henderson.) The general loss of power is as remarkable as the fact that even in cases of extreme poisoning, the mind remains clear. Death probably results from paralysis of the heart.
Colchicum is one of many examples of the great difference in both the degree and kind of action which drugs exert on the organism of different animals. In very small doses it is fatal to dogs, producing violent emeto-cathartic action. Hence the French call it TUECHIEN. In cows it produces scanty urine, great distention of the abdomen, but no profuse diarrhoea. In rabbits it produces enuresis, but hardly any serious symptoms. A frog will take with impunity a dose that would speedily kill a large dog. This example shows the fallacy of deducing from experiments on animals rules for the use of drugs in diseases of the human organism.
The following summary of the action of Colchicum upon the healthy human subject is derived from Stapf's proving, in the "Archives of the Homeopathic Art," vol. vi., and from records of provings which are abundant in medical literature, and of which an excellent summary is given by Hartlaub, in the " Homeopathische Vierteljahrschrift," vol. viii. The provings are still very imperfect.
SPHERE OF ACTION. Taking a general view of the action of Colchicum, we find it to be exerted chiefly on the bones (or periosteum), on the synovial membranes of the joints, on the urinary and digestive organs, and upon that part of the nervous system which presides over the function of voluntary motion. It acts also somewhat upon the respiratory organs. It therefore acts with about equal scope upon both the vital force and the organic substance.
It is a remarkable fact that although the action of Colchicum upon the regions and tissues already named is very energetic, the drug being a poison of a speedy and fatal action, even in moderate doses, yet upon the sensorium it produces almost no effect, the mind remaining clear to the last.
SENSATIONS. The sensations which Colchicum produces are a shuddering and creeping in isolated parts of the body, such as are wont to be felt on getting cold from change of weather. Also, a tearing, tensive pain in small portions of the body at a time, and quickly changing its location from one part to another. Also, sudden tearing shocks or jerkings throughout one entire half of the body. Sometimes sticking or jerking drawings, or weak drawing and tearing in various muscles. The most distressing pains are the sticking shocks or jerks, which are felt deep in the soft parts, and, as it were, upon the periosteum.
AGGRAVATION. They are worse at night, and deprive the patient of sleep.
CONCOMITANTS. They are attended by a symptom which is characteristic of Colchicum, viz., a feeling of muscular weakness or paralysis, and this feeling it is which interferes with the patient's locomotion. Finally, there are sticking pains in the joints.
The weakness is very great; the whole body is sore and sensitive; there is a sensation of trembling felt throughout the body; all the muscles of voluntary motion, but especially those of the arms and legs, are paralyzed. The knees strike together, and the patient can hardly walk.
PECULIARITIES. The pains are much aggravated at night, becoming intolerable, and they are aggravated also by any mental exertion or by emotion. There is great sleepiness during the day, with indisposition to exertion of any kind, and confusion and dullness of the head. At night, however, the sleep is disturbed or driven away by pains. If he sleep, the patient is wakened by frightful dreams.
As regards fever, we observe chilliness through the limbs or down the back, sometimes dry heat, especially at night. Sweat copious and sour. But in general the febrile symptoms are few and moderate in intensity.
The sensorium is no further affected than that it partakes, in some degree, of the general depressed condition. The memory is weakened, and the ideas are not so clear as is customary with the patient.
Coming now to the special analysis, we find:
HEAD. Pressing pains, above, in small spots or very severely in the substance of the cerebellum, and occurring on the slightest intellectual exertion; a pressing heaviness in the cerebellum, especially on moving or stooping forward.
Tearing pains, sometimes in one-half of the head and sometimes in the occiput (the pains, as already stated, wander), sometimes in the temples, sometimes in the pericranium. A pressing tearing in the occiput, finally a very painful, drawing tearing in one-half of the head, beginning at the ball of the eye and extending to the occiput. (This reminds us of Spigelia, which has a similar symptom on the left side, and of Silicea and Belladonna on the right side.)
CHARACTER. To recapitulate, the pains are tearing, drawing and pressing. They are most frequent in the occiput, and are often semi-lateral. The characteristic symptom is the severe pressing pain deep in the substance of the cerebellum, occurring on the slightest intellectual exertion.
Some remarkable symptoms are recorded of the EYES. Drawing, digging pains deep in the orbit, resembling those of sclerotitis. Pressure and biting in the canthi with moderate lachrymation. Violent sharp tearing pains in the globe of the eye and around the orbit.
FACE. The expression of the face is that of a chronic patient. There are tearing and tensive pains in the facial muscles, moving from one location to another. Likewise drawing in the bones of the face and nose, a sensation as if they were being rent asunder.
The teeth are very sensitive when pressed together, as in biting. Tearing in the jaws and gums; the teeth feel too long. The pains in the teeth are aggravated when, immediately after taking something warm into the mouth, the patient takes something cold.
In the tongue, tearing, burning and sticking. Also a loss of sensibility in the tongue, the first symptom we encounter of the Colchicum paralysis.
In the throat, a tickling as if a coryza were setting in, which induces the patient to cough and to clear the throat. The mucus is thin and greenish and comes sometimes involuntarily into the mouth. Externally, in the cervical muscles, sometimes a pressing pain, sometimes a tension, felt even when swallowing. The throat is dry, and yet there is a flow of watery saliva, accompanied by nausea, fullness and discomfort in the abdomen.
In the digestive apparatus, we find considerable thirst, but absence of appetite. Frequent and copious eructations of tasteless gas. Nausea with great restlessness and, on assuming the upright posture, a qualmishness in the stomach and inclination to vomit. Violent retching, followed by copious and forcible vomiting of food and then of bile. If the patient lie perfectly still, the disposition to vomit is less urgent. Every motion renews it. (This is characteristic also of Tabacum and Veratrum.)
The pit of the stomach becomes very sensitive to touch and pressure. Sometimes there is a burning sensation in the stomach, more frequently a feeling of icy coldness, accompanied by great pain and debility. (I cannot forbear remarking here the similarity of this symptom to one form of "retrocessed gout").
Pressing, tearing, cutting and stitching pains in the abdomen. Great distention of the abdomen with gas, feeling as though the patient had eaten too much. This condition affects particularly the upper part, under the short ribs.
Tearing and burning at the orifice of the rectum are frequent symptoms, and prolapsus ani has been observed.
The symptoms of the stool present two characters depending on the magnitude of the dose and the period that has elapsed since the drug was taken, and also upon the extent to which other emunctories are affected. For, if there be copious salivation and copious secretion of urine, the stool will be scanty and attended by tenesmus, and VICE VERSA. Thus, then, if the intestinal canal be the seat of the most powerful action of Colchicum, and if the symptoms be observed early, we have copious, frequent watery or bilious stools, often without pain, sometimes accompanied by cutting colic.
On the other hand, we observe scanty and difficult evacuation of a stool consisting of bloody mucus and shreds, with pains in the anus, great straining and a spasmodic action of the sphincter, and constant ineffectual effort to pass faeces. (Colchicum, taking these symptoms in connection with its rheumatic and semi-typhoid symptoms, will be, as it has proved itself, a valuable remedy in many cases of autumnal dysentery.)
Upon the urinary organs we have the same twofold action. The secretion is sometimes very copious, watery and frequent. But, generally, in the human subject the secretion of urine is diminished ; the urine is dark, turbid, and its evacuation is attended and followed by tenesmus of the bladder, and a burning pain in the urethra as if the urine were very warm.
RESPIRATION. On the respiratory organs the action of Colchicum is a subject of dispute among old-school authorities. We find it produces a long-lasting coryza, which is never watery, but is characterized by secretion of abundant tenacious mucus, tickling in the trachea and a little cough.
It produces frequent oppression of the chest, dyspnoea, a tensive feeling in the chest, sometimes high in the chest, and sometimes low down. These symptoms point to the efficacy of Colchicum in some forms of asthma, a subject on which old-school doctors differ. Homeopaths have often used it very successfully in asthma.
In the posterior part of the thorax, dull stitches, as much in the back as in the ribs. It is characteristic of these stitches that they are chiefly felt during expiration and not during inspiration.
BACK. In the back we note the various kinds of drawing tensive and stitching pains remarked elsewhere. They occur or are much aggravated on motion. On the sacrum, a spot as large as one's hand which feels sore, as if ulcerated, and is very sensitive to the touch.
EXTREMITIES. In the extremities, tearing pains in both muscles and joints, stitching pain in the joints. The pains wander from part to part. They are aggravated by motion and at night. They feel as if in the periosteum. Conjoined with the pains is a very distressing paralytic feeling, together with an actual loss of muscular power approximating paralysis. The action of Colchicum is more marked on the small joints than on the large.
APPLICATION. Colchicum was regarded by the ancient Greek and Arabian physicians as a specific for gout, but a somewhat dangerous remedy. It fell into disuse until Stoerck, in Vienna, in the eighteenth century, called attention to it. He proved it in a rude way, and vaunted it as a remedy for gout, rheumatism, asthma and dropsies. Its efficacy in asthma, affirmed by many physicians, has been denied by others, except the asthma depend on hydro-thorax or hydro-pericardium, in which cases it is admitted Colchicum may relieve by removing the dropsical effusion. Stoerck's recommendation of Colchicum as a remedy in gout did not attract much attention until it was found that Colchicum was the chief ingredient of several famous nostrums for gout, as the EAU MEDICINALE of Husson and the pills of Lartigue and others. At the present day its value is recognized and we all have opportunities to see the mischief inflicted by its improper uses.
Alexander of Tralles, in the fifth century, and Mr. Barwell, in 1860, affirm that it predisposes to relapses. In cases in which it does so it cannot be the true remedy.
It has been a subject of discussion whether it acts specifically in gout or only by virtue of its hydragogue properties. The question is settled by the fact that other hydragogues do not relieve gout as Colchicum does. Also by the fact which I have myself seen, and which is attested by many physicians, that its action is manifest in relieving the gout only or chiefly when means are taken to prevent its action on the bowels, as by combining Opium with it, or by copious draughts of rice-water.
Having alluded to injurious effects upon the use of Colchicum, I will quote a few sentences from "Barwell on the Joints," p. 176:
Colchicum is a remedy whose value is undoubted, but its influences for evil are almost as certain; it is more powerful in gout than in rheumatism. It has a power in checking the pains, etc., of both rheumatic and gouty diseases, but it also has an effect in procuring relapses. Persons who have been treated with this remedy suffer from the return of the disease more rapidly than those treated by some other medicine.
Dr. Tod says the relapses are apt to assume an asthenic character, p. 224.
Colchicum is a two-edged sword of considerable sharpness; there is no doubt of its great power in checking gouty and even rheumatic pains; but it is very questionable whether it does so in a beneficial manner. The late Dr. Tod believed that it changes the common acute form of gout into an asthenic condition which is less easy of management; and there is great reason to believe this idea correct. Any practical opinion which is the result of experience, not of mere A PRIORI reasoning, deserves great attention ; and we may be sure of this fact, that whatever the MODUS OPERANDI of the drug may be, it hastens relapses, renders each one less amenable to treatment and requiring larger doses of the medicine (if treated with Colchicum) than its predecessors. Whether the remedy act simply as a purgative, or as stimulating the liver, or as causing a larger excretion of lithic acid, is not certain; but its use is permissible only when the constitution is vigorous, and it should not be given except when other means of procuring ease have failed.
I fancy that every one who has seen cases of gout or rheumatism treated by Colchicum will indorse the statements of Mr. Barwell and Dr. Tod. Yet they are wrong in banishing Colchicum from the list of remedies to be employed at the beginning of treatment. It has its place in the treatment of gout and rheumatism, and if properly employed in appropriate cases will do good, and good only. Allopathic authors are almost unanimous in recommending Colchicum as Mr. Barwell does, as suitable only in persons of vigorous constitution, and in whom the manifestations of the disease are acute and active or only approaching the sub-acute, and they caution us against using it in feeble cases and in asthenic conditions. Why ? Because, as they tell us, its tendency is to produce an asthenic condition, and none but vigorous patients can bear it. Others would be reduced too low. Here we have the old idea of antagonism between the action of the drug and that of the morbid organism, the latter not being regarded (as I think it should be) as engaged in a struggle against the morbific influence, of which struggle the symptoms are the phenomena, and in which struggle the drug should act in co-operation with the organism and in the same direction as the symptoms.
If we look at the symptoms produced by Colchicum, we find the rheumatic or gouty symptoms characterized by a debility, a paralytic weakness, very suggestive of an asthenic type of disease. The fact that Dr. Tod and Mr. Barwell have observed the tendency of Colchicum to turn the active into the asthenic form of gout, furnishes additional evidence of this mode of action of Colchicum. Now, it is in precisely this form of asthenic sub-acute disease that Colchicum is truly indicated and does real service. But, what of the danger of reducing the patient? None whatever, provided we give doses so small as not to produce the physiological effects, but only the specific effects, which are known to be produced when the symptoms disappear. These doses, however, must be very small, and, noted as homeopathicians are for giving small doses, many of that school err in these cases in giving doses too large. I do not think it safe to give, in a well-marked Colchicum case, a larger dose than the 15th potency.
Dr. Wurmb speaks of Colchicum in its relations to rheumatism, as follows:
This drug stands in close relation to the fibrous tissues; it produces, on the healthy, pains which are very similar to those of rheumatism ; it excites a condition of irritation which is very closely allied to inflammation,—redness, swelling, heat, etc.; like rheumatic inflammation, this does not tend to suppuration, and it easily and quickly changes its location. In the Colchicum fever, as in the rheumatic, the cold stage predominates, the sweat is very copious, etc., the urine and sweat have an acid smell and reaction.
These features closely resemble those of a rheumatic attack. Yet, if we look at the entire action of Colchicum, we shall perceive that it cannot play an exceedingly important role in the treatment of rheumatism. For it produces another series of symptoms which would often contra-indicate it in rheumatism. For example, the muscular weakness, the paralytic symptoms, the diminution of vital heat, the capillary congestions, all which symptoms indicate a vital atony.
Consequently, we should rarely find Colchicum indicated in the beginning of rheumatic disease, rather only when feeble, debilitated persons have suffered from it a long time.
It appears especially suitable to cases in which we perceive, on the one hand, an active excitement in the local symptoms, and, on the other, symptoms of torpor in the general condition of the patient.
Colchicum was recommended in 1833 against Asiatic cholera in England, and used successfully in eight cases. But as Dr. Stille says, "notwithstanding its homeopathic appropriateness, it has not been used by others."
In autumnal dysenteries we have already alluded to its successful use.
It has been used as a diuretic and palliates dropsies. It may be useful in irritation of the bladder, and has been successfully employed in Bright's disease.
Ruckert reports its success in asthma. It quiets the heart's action. On the healthy it produces violent palpitation.
Boenninghausen, whose veterinary practice was extensive, lauded Colchicum, as a specific for the excessive flatulent distention of the abdomen in cows who have been allowed to eat too freely of clover. This affection is very fatal. A single dose of Colchicum 200 gives prompt relief. This may direct our attention to Colchicum in tympanitis after certain kinds of food in the human subject.
Before leaving the subject of Colchicum, I would call attention to the fact that in many cases of poisoning by it cataracts have formed before death in the eyes of the sufferers.
Professor Hoppe reports that with Colchicum he greatly benefited, though he failed to cure, three cases of soft cataract.