colchicum, it is well known, gives re lief from the pain, inflammation, and fever of gout. But how? Does it cause thc elimination of uric acid through the kidneys and so remove the condition on which the gout immediately- depends? Since Garrod has experimentally shown that colchicum exerts no influence on the elimination of uric acid in gouty people, it is evident that the drug must control gouty inflammation without, in any way, affecting the condition on which such inflammation, in the first in stance, depends. Hence, colchicum should be merely palliative, removing, for a time, the patient's sufferings, but in no way protecting him from their recur rence. Many who suffer from gout are of opinion that, while the medicine will remove altogether an existing attack, it insures the speedy return of another. Ringer and Sainsbury ("Hand-book of Then," '97).
Colchicine in a general way acts like colchicum, but the action of colchicein. has not been determined with any degree of definiteness.
On the heart and circulation colchicine produces very little effect, though large doses cause a fall of arterial pressure and slight slowing of pulse, due to de- . pression of the heart.
Colchicein, in poisonous doses, induces marked weakness, stupor, and lowering of bodily temperature; decreases reflex activity, not by depressing the sensory nerves as does colchicine, but by acting on the motor nerve-trunks. Leon (Univ. Med. Mag.„Bily, Aug., '85).
Two or three hours after the intrav enous injection of colchieine the symp toms of general poisoning appear. The first symptoms are nausea, followed by more or less vomiting and diarrlura; next, alteration in the motility, taking on the form of ascending central paraly sis. When the paralysis reaches the anterior extremities, disturbance of res piration occurs: the respiratory move. ments become greatly increased in power and greatly decrea.sed in number, until death ensues, owing to arrest of respira tion. In rare cases, immediately before death, convulsions occur, which are at tributable to asphyxia.. The heart re mains beating for perhaps twenty min utes after breathing has been arrested. Jacobi (Schmidt's Jahrbuch, Sept.; Therap. Gaz., Oct., '90).
Colchicum and its salts are contra indicated when there is a great amount of debility, a profuse diarrhcea, and in asthenic gout. It is worthy of remark that most of the untoward effects chron icled from time to time have appeared in conjunction with the administration of wine of colchicum-seed. On the other hand, much of the corm, or "root," em ployed by manufacturers is worthless.
Therapeutics. — RHEUISIATISM A N D GOUT.—In all forms of sthenic rheuma tism and gout the relief that colchicum gives is incomparably greater than- that afforded by any other single remedy, but the mode in which it is best given, the period best suited for its administration, and even the patients for which it is suited are points which demand serious consideration. It is by no means an
agent to be prescribed hap-hazard and indiscriminately, nor one which will, in all cases, produce equally beneficial re sults. The maxims laid down by Todd cannot be improved -upon, viz.: Never give it at the outset of a paroxysm, not until the bowels have been acted upon by a mild purgative. Let the first doses, always, be small, and subsequently grad ually and progressively increased. At first administer uncornbined with any other remedy until assurance is had that it is not likely to disagree with the patient; and do not push to a degree that will excite nausea, vomiting, or purging: these should be regarded as in clicative of unfavorable operation. It may be regarded as acting favorably when, under its use, the volume of urine is increased; when an abundant supply of bile is discharged; when the fxces, though solid, are surrounded by mucus; and when the skin secretes freely. Its effects should be carefully watched, as it is likely to accumulate in the 'system. It is inadmissible where the patient is advanced in years, who has had several attacks and in whom the malady seems too deeply rooted to be influenced by the temporary administration of the remedy.
It is necessary to continue the use of colchicum for many days after the entire - cessation of the symptoms; but the doses may be gradually diminished, and at the same time the intervals lengthened; also, if the malady does not give way by the time the boi,vels are affected by the ,drug, it is useless to push it further.
Gout is the one disease in which col chicum is almost universally recognized as a specific. It may be advantageously employed both as a preventive of the paroxysm and to lessen its severity when developed. It should always be borne in mind that, although looseness of the bowels may be useful, yet when colchicum purges the gouty- patient actively it mostly fails in achieving the desired therapeutic result. Its action is most favorable when its influence is felt chiefly upon the skin and kidneys; and to efTect this it is often well to restrain the tendency of the drug to act upon the bowels by combining it with opium. This is especially the case in debilitated subjects, in whom anything like overpurgation mnst be avoided with the most scrupulous care. By large purgatives doses of colchicum the paroxysm of gont may often be sup pressed, but experience has shown this use of the drug is dangerous, the sup pression being sometimes followed by serious internal diseases, apparently due to a transfer of the gouty irritation. Between the paroxysms colchicum may be steadily exhibited to the gouty sub jcet in small doses, and often great ad vantage is derived from its combination with pota.ssium iodide; this combina tion is especially useful in irregular atonic gout such as is frequently seen in women of feeble nervous organization who have inherited the diathesis, but is sometimes present in robust men.