Colchicum.
The dried (I) root and (II) seed of Colchicum autumnale, Linné (Nat. Ord. Liliaceae.) England and other parts of Europe. Dose, Corm, 1 to 5 grains; seed, 1 to 5 grains.
Common Names.—I. Colchicum Corm (Colchici Cormus); II. Colchicum Seed (Colchici Semen).
Principal Constituent.—The powerful alkaloid Colchicine (see below.)
Derivative.—Colchicina, Colchicine. A very toxic alkaloid occurring as pale yellow scales or powder, practically odorless. It should not be tasted. Soluble in water. The salicylate is sometimes employed. Dose, 1/300 to 1/100 grain.
Preparation.—Specific Medicine Colchicum. Dose, 1 to 10 drops.
Specific Indications.—Acute gout; rheumatism, without much fever, occurring in gouty individuals; tearing pain, aggravated by heat.
Action and Toxicology.—Upon the skin and mucosa colchicum is irritant, causing smarting and redness, sneezing and conjunctival hyperemia. Small doses increase the secretions of the skin, kidneys, liver, and bowels. Large doses are dangerous, producing gastric discomfort, nausea and vomiting and purging, and violent peristalsis with much intestinal gurgling. Poisonous doses produce a violent gastro-enteric irritation, with symptoms much like those of cholera-agonizing griping, painful muscular cramps in the legs and feet, large but not bloody evacuations of heavy mucus and serum, thready pulse, collapse, and death. Toxic doses are almost sure to kill in spite of efforts to save life, the patient dying a slow, painful, and agonizing death, the final act of which is respiratory paralysis. Consciousness remains to the end.
The reputed antidote is tannin freely administered with plenty of water and followed by the use of emetics or the stomach pump. Opium may be given to relieve pain, atropine to sustain breathing, and artificial heat to maintain bodily warmth.
Therapy.—Colchicum is an extremely dangerous medicine and should be used with the greatest of caution. It is the remedy for acute gout, temporarily giving quick relief if administered short of purgation. For some unknown reason attacks recur more frequently when colchicum has been used, though it almost magically relieves the paroxysms. It is useful for disorders depending upon a gouty diathesis, though it is less effectual in chronic gout than in the acute form. In rheumatism, pure and simple, it usually has little or no value, though we have had excellent results after failure with the usual antirheumatics, in cases where pain persisted in one part for longer periods than usual, in acute articular rheumatism with but little fever. These cases resembled gonorrheal arthritis and were accompanied by a leucorrheal discharge, but were not gonococcic. In most cases the fingers, wrists, and abdomen were the most painful locations. Some have advised it in so-called chronic rheumatism when the patient is known to have occasional gouty attacks. We have seen it do good in rheumatoid arthritis; a condition much more prevalent in this country than genuine gout, a disease rarely encountered in America. In rheumatoid headache and in rheumatic iritis colchicum is sometimes of value when occurring in one with swollen joints, with or without effusion, and attended by tearing, muscular pain, aggravated by heat. Subacute and chronic sciatica are asserted to have been relieved by colchicum when the pain is sharp, shooting, tearing, or dull, from back to hips and down the legs, fever being absent.
In rheumatic conditions colchicine salicylate in doses of the 1/128 grain is often more serviceable than colchicum.
