It is worthy of note that many drugs highly esteemed, and frequently used by the old school, and with their ordinary measure of success, have been but very imperfectly proved, and are consequently little known or used by our own. Among them is Colchicum. It is believed the following case of poisoning, add materially to the recorded pathogenesis of this drug. The first was the result of swallowing a quantity of the alcoholic tincture of the seeds — it being mistaken for tincture of orange peel. Quantity not given. About five hours after the swallowing, the patient, a man of 30 years, had squeezing and severe pressure in the epigastrium; sensation as if a ligature were drawn tight round the chest; difficult breathing; strong burning in the mouth; and difficult swallowing. Alternating chills and heat soon followed with anxiety, violent vomiting and diarrhea. Eighteen hours after taking the drug, he had pale and sunken face, eyes sunken, with dark rings about them, pupils contracted, anxious expression of countenance; difficult swallowing, with pain through the whole extent of the esophagus, tongue moist with thick yellow coating; the abdomen spasmodically drawn inward. Pressure on the bowels increased the anxiety and difficulty of breathing. A large quantity of yellowish green water was vomited, the stools were copious, orange yellow, slimy and liquid, with many large light colored flocks, exceedingly offensive, without pus and without tenesmus Unextinguishable thirst for cold drinks; skin cool; extremities cold; pulse small, contracted, and 80 in the minute.
Autopsy. — The entire small intestines, especially the duodenum and jejunum exhibited on the peritoneal surface, brownish spots, of an inch and a half in diameter, with Strongly injected vessels. The mucous surface of these spots showed intense inflammation, the more marked the nearer the stomach; swelling of Peyer's and Brunner's glands, and softening of their mucous surface, but not so as to admit of separation from the muscular tissue. The whole mesentery was also inflamed, and its blood vessels strongly injected with black blood. The stomach distended to three times its ordinary size, was of deep red color on its peritoneal surface, and one spot quite dark. It contained an enormous quantity of offensive gas, and three tea-cupsfull of a yellow stinking fluid. The mucous surface was dark red, almost brown, much thickened, but not separable from its connections, with the scalpel.
Case II. — The patient in this case was a female 25 years of age, of a nervous temperament, in perfect health of body, who swallowed about 5 ounces of the vinous tincture of the bulb, 7 o'clock P. M. Immediately she had severe pains in the stomach; five hours after she was cold, pale, lying on the back; the epigastrium exceedingly sensitive to pressure, the surface of the abdomen hotter than the rest of the body; lips violet color, eyes closed, the pulse thready and very slow, breathing extremely difficult, consciousness clear, with desire for death; violent cramps in the soles of the feet; incessant vomiting of small quantities of a colorless fluid, without odor. The next morning, at 6 o'clock, the patient was greatly prostrated, heat of epigastrium lessened; eyes hollow; vomiting had ceased; pulse increased in frequency and strength; cramps less severe. At 3 o'clock P. M., pulse only to be found in the carotids; consciousness still clear. Death at 5 o'clock — 22 hours after the poisoning.
Case III. — A man, age not given, ate at 6 o'clock P. M., May 11th, 1838, about two ounces of the leaves of the Colchicum, mistaking them for the leaves of the white beet. Six hours after he had nausea, retching, vomiting, colic, urgency to tool and diarrhea. The vomiting and diarrhea were so severe at 7 A. M. of the 12th, that no remedies could be administered. The features were then distorted — the muscles supplied by the nervus facialis were affected by spasms, almost like as is found in Asiatic cholera, and inclined to semblance of Risus Sardonicus, — pupils much dilated, but very little sensitive to light — brain free — hearing good — tongue moist, blueish at the root — drawing, like rheumatic pain, in the nape of the neck — pressure in the esophagus — a sense of burning in the solar plexus — pressure upon stomach and abdomen does not increase pain — abdominal muscles spasmodically contracted — vomiting and diarrhea more watery but not very copious, alternating with tenesmus — skin very cool — pulse slow, hard, tense, somewhat thready, secretion of urine suppressed — fingers rigidly extended — cramps in the calves of the legs. On the 13th, between 3 and 4 A. M. delirium, cephalgia. At 7 staring, sunken, dull eyes.
Risus Sardonicus. — Tongue entirely blue — breath cold — loss of speech — intellect active — the extremities marked with purple streaks; pulseless; skin on extremities warm, on the abdomen cold; suddenly appearing spasmodic motions of the muscles of the neck and mouth; no post mortem examination.
Case IV. — A man 52 years old, of sanguine temperament, took by mistake about five ounces of a decoction of the seeds of Colchicum, and got griping in the bowels with diarrhea and vomiting. Abdomen not swollen; the region of the stomach spasmodically contracted; pulse small and somewhat accelerated; very offensive fluid stools with white flocks; the next morning at 9 o'clock, the patient was pale, respiration very rapid; gasping and sighing; voice hoarse; hollow eyes; pupils much dilated; pain in the forehead; tongue coated white and was protruded with difficulty; the region of the stomach painful to pressure; breath, face and extremities cold; pulse very quick and hardly perceptible; the stools last night and this morning contain a clear blue matter, sometimes in a larger and sometimes in a smaller quantity; the night was sleepless. His intellect sems beclouded, though he gives correct answers to questions; unless questioned he says nothing of his condition which does not appear to him dangerous.
Section. — Inflammation was found at the bifurcation of the trachea which did not extend into the lungs, the lungs were small, pale, with a doughy feel but of normal texture. The heart on its upper and lower surface had large black, violet and brown spots, circumscribed, cloudy, which could not be wiped away; the cavities filled with clotted blood; the esophagus at its junction with the stomach was red passing into brown; the inflammation of the cardiac extremity of the stomach was very marked, of a blackish violet passing into brown; externally the peritoneal coat of the stomach was of a clear violet color passing gradually into its normal hue; on the mucous surface the same color was found passing up into the esophagus when it lost itself in the natural color; the veins of the stomach distended with thick black blood, the concave surface of the liver near the stomach was of a violet color; gall bladder filled with green yellow bile and very large; the vessels of the messentery were distended with thick black blood; the large and small intestines externally scarcely at all inflamed, but on the mucous surface showed here and there traces of a red brown color.
Case V. — A boy 4 years old, ate a quantity of colchicum seeds, and was found some time after by his physician lying on his back in a comatose state, eyes half open, respiration audible and accelerated; face sunken and already hippocratic, expression dull, pupils immovable and but little dilated, tongue protruded with difficulty, bright red, with slimy coat on the root, abdomen distended, tense and hard; urine copious, pain in the calves of the legs and feet; vomiting of food and pale greenish slime; pulse small and contracted; skin dry; trunk hot, extremities cold, great prostration, inextinguishable thirst, vomiting passed into hiccough; forehead covered with cold sweat, stool involuntary, fainting, short groaning respiration, retching, great and burning thirst, impulse of the heart weak and hardly perceptible, death.
Section, — Redness of the peritoneum and external surface of the intestines, the mucous membrane on the great curvature of the stomach and near the cardia softened and here and there abraded spots from the size of a sixpence to that of a half dollar, redness extended from the margins of these spots over the inner surface of the stomach; the whole mucous membrane softened and easily removed from its connections, in the small intestine the mucous surface as far as the cecal valve, was red, soft and abraded; internal surface of kidneys, red.
Case VI — A girl twenty years old, swallowed between 4 and 5 ounces of the vinous tincture of the root. This girl was sister of the patient of the second case here reported. The symptoms developed are declared by the reporter to be identical with those of that case. He gives only as peculiar to this, severe pain in the epigastrium; repeated vomiting without diarrhea, squeezing together of the chest, extreme dyspnea, violently painful cramps in both feet, especially in the left, with very severe and continued pain in the left knee; pulse small and contracted, intelligence clear till death.
Section. — The vessels of the pia mater and substance of the brain were much injected, especially in the posterior fourth, not in the anterior fourth. After the most careful inspection of the stomach neither red spots nor vascular injection were found. Its inner surface was covered with grey mucus; the mucous membrane was so softened that it was readily separated from the muscular coat, not in strips, but in the form of a pulp. In the duodenum the mucous glands were enlarged to the size of a mustard seed; in the lower part of the ilium the mucous follicles were enlarged and o a violet color.
Case VII. — A boy six years old, ate a considerable quantity of the root of Colchicum on the 26th of June, 1830. On returning to the house in the evening he complained of pain in the head and right wrist, with thirst. After drinking two cups of sweet milk, though restless, he fell asleep, the whole body was scarlet red, about 11 o'clock he was seized with a trembling of the limbs which passed into violent convulsive movements, with a flow of white froth from the mouth, in one quarter of an hour the movements ended in opisthotonos. After quiet sleep till 2 o'clock there was a second attack similar in kind and duration, after which he vomited twice from.3 to 4 ounces of the half masticated bulb and then of a grass green tenacious fluid.
On the 27th he was extremely restless, constant turning: of the head from right to left, complained constantly of pain in both forearms, which were extremely sensitive to the slightest touch, skin livid, dry and hot, eyelids in constant motion, pupils much dilated, unconscious and pulseless, lies constantly on the back, moves only the left foot and right arm, when covered, the skin is hot, except soles of the feet which with nose and cheeks are cold; uncovered, the skin takes on goose flesh immediately.
On the 28th and 20th, breathing irregular, grinding of the teeth, frequent carpologia, evacuations of feces and urine involuntary, urine profuse; the patient was able at times to sleep quietly, the hearing improved, skin more natural in temperature and color, pulse 185 to 190, pupils less dilated
On the 3d, after the application of six leeches these affections of the eye somewhat abated, elbow and knee of left side swollen, hot and painful to touch; right side paralyzed, hearing gone, frequent grinding of the teeth, gastricismus, lips, teeth and tongue covered with a thick brown coating, thirst increased, the paralyzed side is insensible except the toes which seem to be abnormally sensitive and are drawn toward the sole on the slightest touch, if the patient be raised up the head falls constantly backward, and the mouth opens to the widest extent; pulse 190 to 193, cornea very convex and pointed, the clouded lens presses toward the pupil, the eye appears as if pressed from its socket.
On the 5th, convulsions of the left side and face, especially of the mouth, which lasted twenty minutes, grinding of the teeth with little intermission the whole day, both eyes are constantly turned toward the sunlight.
The 7th, left thumb drawn down to the palm of the hand, quantity of urine enormous, on shutting and suddenly opening the eye there appears behind the slightly expanded pupil a yellowish looking membrane.
On the 8th, the brown coating of tongue and lips increased, sclerotica more red especially the inner angle, the membrane has pressed itself into the anterior chamber of the eye where it remains immovable, it is 2 lines long and 1 1-2 broad, the clouded lense is same in the posterior chamber, but much smaller than natural, iris dull, the pupil very sensitive to the least impression of light.
The 10th, pulse small and hard, 180 to 185, copious discharge of urine every 1-4 hour. His condition remained unchanged except that he emaciated rapidly and greatly till the 24th, frequent grinding of the teeth, with convulsions of the left side, and the balls of both eyes; tongue coated white, skin hot and dry, the right arm lay motionless on the breast, the thumb drawn down on the palm of the hand and the fingers spasmodically closed over it, perceptions entirely lost.
The 27th, the patient vomited all his ingesta, the extremities were all spasmodically contracted, the fingers and toes drawn into balls, the eyes roll convulsively, the left hand trembles, abdomen of doughy feel not swollen but sensitive to pressure, pupil of left eye more contracted, right dilated, pulse thready, hardly perceptible, 190, 195, strong beating of the heart, respiration for some days has been intermittent, convulsions extending over the muscles of the neck and face, the under jaw closed firmly on the upper, frothing at the mouth.
On the night between the 8th and 9th of August, these spasmodic symptoms disappeared, the right eye rolled constantly while the left turned toward the inner can thus and was slightly convulsed, right pupil moderately dilated, the left much contracted, nostrils dry and black, face and skin alternately livid and bright red, face covered with perspiration, the right arm cannot be extended, the left cannot be bent, the feet spasmodically drawn upward, the soles bent to a crescent and the toes pressed on the soles, extreme emaciation, the beating of pulse and heart hardly perceptible.
The 14th, the most violent convulsions, the distorted limbs are thrown in all directions, the left fore arm pressed close on the arm, the hand on the shoulder, the fingers clenched, the head was drawn backward, the abdominal muscles were swollen, the spine bent forward, and the abdominal parieties pressed back upon the lumbar vertebrae, the paralyzed right side was not involved in the spasm. Death at 3 o'clock.
Case VIII. — A lady 50 years old, of a nervous temperament, took 30 grammes of Tr. Colchici, by mistake, Sept. 16th 1845, at 7 A. M. In five minutes she had fearful pains in the stomach and bowels, with extreme anxiety, was much excited and restless, face pale, sunken eyes with dark circle, the intestines insupportably painful, sense of compression of the chest and suffocation, pulse 50 and weak, extremities cold, vomiting of a tenacious matter, numerous liquid, black, offensive stools with severe colic pains.
It will be noticed that the above eight cases present a great variety in the phenomena developed, and in the organs chiefly affected. It may be a question whether this difference was owing to individual idiosinerasy, or the different parts of the plant, or different preparations employed. In this respect there was considerable variety. In three cases the seeds were used, in three the root, in one the leaves. The seeds were used in alcoholic tincture, in decoction and were eaten raw; the bulb in alcoholic and vinous tinctures and was eaten raw.
The developments of abdominal inflammation incases 220.127.116.11. are worthy of note, and indicate valuable curative relations to peritonitis, inflammation of the mucous surfaces of both stomach and intestines and to that condition of the mucous follicles which Louis declares to be the esse of typhoid fever. In cases 1. 3. 4. and 8. groups of symptom resembling Asiatic cholera cannot fail to attract attention, while 1. 3. and 7. present symptoms no less like the most common phenomena of abdominal typhus. The symptoms of the eye and ear are striking and important, as are also those of the brain, spinal cord and kidneys.
It is worthy of remark how small a part in the history of these cases is occupied by symptoms similar to the diseases in which colchicum has been chiefly employed by cur school and the old. Rheumatic pains are mentioned, and so is tenesmus, but neither rheumatism nor dysentery are strongly suggested by any one of the cases, while resemblances are strongly pictured to diseases for which this drug has never been recognized as a curative agent, if we except the treatment of some few cases of remittent fever by Colchicum, the history of which is found in Franks Magazine vol, II in which the cures were effected in astonishingly short time, and with the happiest results in all respects, though the resort to this drug seems to have been, on the part of the practitioner, so far as appears on the record, nothing better than a bold blunder. He seems to have had no other or better reason for giving this remedy than he would have for giving any other agent capable of producing a powerful disturbance in the system. Indeed, it is highly probable that to produce just such a disturbance was the object had in administering the remedy, its specific curative relationship not being at all dreamed of or recognized by him, or by the school to which he belongs, and the cases are reported as rather remarkable curiosities.
It will be borne in mind that the groups of symptoms here appeared so like cholera, fever, etc. were the result of massive i. e, poisonous doses. So in the treatment of these cases of fever the doses were massive, varying from 10 to 60 drops — The question naturally rises here, whether groups of symptoms similar to the results of large doses of drugs require large doses for their cure? and symptoms like the results of minute doses arc best treated by infinitessimal doses! Is there any such practical requirement in the application of the law of our method to the cure of disease? This is a question of much importance, and may occupy the minds of all, but perhaps in the present state of our knowledge on the subject, can only be profitably discussed and satisfactorily answered by those who have had the longest experience, and have made the most extended observations.
Nothing is more certain than that large and minute doses of drugs affect the organism differently. Attomyr has illustrated this most clearly in a paper communicated to the Archiv fur Homoeopatisehe Heilkust, vol. 1, on the size of the dose and its repetition. That the administration of drugs for the cure of the sick according to the law of similarities should require a recognition of this difference, it is far from unphilosophical to suppose. Attomyr believes it does, and gives very plausible reasons for his belief, drawn from the Materia Medica and the nature of disease, i.e., from a supposed resemblance of the action of the disease to the action of the large or small dose of the drug which might be required for its cure. It must be added that however ingenious and plausible the basis of his theory for the size and repetition of doses, it does not seem to be fully supported by the latest and best observations.
Indeed it is only necessary to refer to a very limited clinical experience to show that drugs in infinitessimal doses cure diseases very like the symptoms of their poisonings, viz: — Arsenic in Asiatic cholera, Colocynth in colic and dysentery; Belladonna in spasms; Opium in apoplexy; Nux vomica in tetanus, and many others.
These drugs in highly potentized numbers, do cure these diseases, promptly and satisfactorily. That their administration in massive doses in these diseases is attended with better results, is not proved by any facts in our knowledge.
Another question has suggested itself in view of these cases. What is the value to be attached to the post mortem evidences of inflammation having existed in internal organs during life, and as the probable effect of this drug, which caused the death of the patient? Is this organic change one of the elements of similarity involved in the law of cure, and if so, to what extent? The drug having produced inflammation of certain organs, is it therefore a cure for inflammation of those organs? Is this the kind of similarity which the law requires? What is the similarity of the homoeopathic law?
If these physical phenomena are elements in the requirements of the law of cure, they are certainly not of themselves sufficient guides to the selection of the remedy, in a given case. It is not enough, and all sound observation proves it, that Colchicum has produced inflammation in certain organs, to predicate upon this fact, that it will therefore cure all inflammations of those organs. The law certainly does require similarity of time, circumstance and condition of functional symptoms as well as, if not to the exclusion of, the fact that similar physical phenomena have resulted from the administration of the drug. In the present state of our knowledge, we should be rather warranted in excluding organic changes of tissue from the sum of those phenomena which guide to the selection of the drug for specific cures. As in a case of enlargement of both ovaria, with ascites and anasarca, cough, difficult breathing and hectic; and of years standing, which had been subjected to the best Allopathic treatment in a neighboring city, till the case was declared incurable, and then had been treated homoeopathically for a twelvemonth and abandoned, but was then cured by that master of Materia Medica, Dr. A. F. Haynel of Baltimore, with a single dose of Lycopodium, which was selected with sole reference to the subjective and functional phenomena of the case. In the selection of this drug, the administration of which was followed by such brilliant results, the practitioner did not speculate on the supposed condition of the ovaries or of any other internal organs, but simply interrogated those symptoms of which he could have a positive knowledge, and among these discovered those which were characteristic of this case, and then, in the characteristics of the drug, found the simillimum required by the law of cure. This he deemed his whole duty, and if success is to determine the correctness of his judgment, he is abundantly justified. The organic lesions in the case all disappeared just as completely as if he had made them ever so prominent in his practical dealings with the case, and that too in an incredibly short time. He gave no second dose. Let the man condemn this method of practice, who can show his own different one to be better, by better results. When a case of epilepsy was cured by a single dose of Thuja, the master did not stop to inquire into the supposed condition of internal organic changes, but proceeded in a manner very like that of Dr. H. and with a similar result. When Hahnemann was to cure a case of venereal condylomata, the same method compelled him to employ Chamomilla, though in the pathogenesis of this drug it will be vain to look for the mention of venereal warts. Still, one dose effected a perfect cure. And it is worthy of remark that those who sat themselves to the work of perfecting the provings of Hahnemann, because he did not carry his experiments to the extent of producing organic lesions, and hence their imperfection, have added so very little to the practical value of our Materia Medica.
Is there anything revealed in the dissections of these cases which can be pointed to as characteristic of the drug Colchicum? If the dissections had been made without a knowledge of the drug taken, could any one have told, from the appearances found, what the fatal drug was? Is it not true that the results of the inflammation produced by any one of the class of irritant poisons are so like those produced by all the rest, that from mere post mortem examination no one can be justified in pronouncing the lesions he may discover the effects of any particular drug? If there be this uniform similarity after death, was the similarity of the condition of organs less during the life of the patients, and while they were the subjects of medical treatment? Is this similarity more uniform than the appearances resulting from inflammation in these organs from other causes? Are not these all so like each other that the most acute observer can only say there has been inflammation? How then can these phenomena, all so like each other, become guides to the selection of the specific drug, in an individual case of inflammation? In -the discharge of his practical duties as prescriber of drugs for the cure of the sick, would the physician be relieved of any burden of carefulness or labor, if he could by the acquisition of Some new power, be able to see the exact condition of the suffering internal organs during life, as completely as he can by the aid of the scalpel after death? If all inflammations appear so alike, what is there in an individual case to point to a particular drug as its specific cure?
Is not this objection applicable to the class of objective phenomena generally? As, for example, is not the crepitant rale in one case of inflammation of the lungs just like that of every other? The bellows sound of the heart, the metallic tinkle, and 50 of the whole class of stethoscopic phenomena? How then can these phenomena be a guide to the selection of the curative drug? For it is certain that whatever of similarity there may be in the physical phenomena above referred to, there is no corresponding uniformity in the action of curative agents. That which is a complete specific for one case of pneumonia, for example, is utterly powerless to cure another, though the physical signs may be the same in the two. Is it not clear, from these considerations, that whatever of value there may be in a knowledge of these phenomena, and it is not intended for a moment to lessen its consideration, it can never be, to any great extent, even an accessory in the selection of drug agents for the cure of disease!
The 7th case is remarkable for its duration, 49 days. If there be truth in the supposed increased value of symptoms, the more remote their manifestation from the taking of the drug, those of the last days in the life of this little boy must have a special significance, and are no doubt to be regarded as especially characteristic of the drug.
|The AMERICAN HOMOEOPATHIC REVIEW Vol. 02 No. 03, 1859, pages 124-137
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