But it should be observed that at least three other explanations of the action of this remedy have been proposed, each of which is possessed of a degree of plausibility.
Some have ascribed its efficacy to the union of a cathartic with a sedative effect, and have even substituted for it a combination of Opium with a drastic purgative. Those who adopt this view of its action aver that Colchicum acts best when it purges freely. But though Purgatives are often of use in gouty disorders, it is generally found that Colchicum operates most favourably when given in too small a dose to produce any purging.
Colchicum stimulates the function of the liver, which is generally deranged in gouty disorders. Mercury, which also promotes the secretion of bile, is in this way useful in Gout. It seems that the formation of this secretion is in some manner essential to the integrity of those blood-processes which are disturbed in arthritic diseases. It might therefore be supposed that Colchicum too acted as a Cholagogue. But it is not clear that it increases the secretion of the bile in any very marked degree.
Thirdly, it is affirmed by some that this medicine is of use in eliminating uric acid from the blood, this product being supposed to accumulate in the system before the paroxysm of Gout. It is said that under the action of Colchicum the natural amount of this substance in the urine is much increased. This would be an important fact if it were certainly proved. But it does not seem to be so; nor is it clearly shown that the observed increase in uric acid is not a symptom of the disorder, rather than of the treatment.
Colchicum is more or less applicable in the gouty forms of Rheumatism, in Lithiasis, and in acid dyspepsia, but it is most efficient in the simple gouty paroxysm.
There are several objections to the indiscriminate use of this remedy. Some have observed that though it cures for a time the gouty attack, it causes the next assault of the disease to recur more quickly than it would otherwise have done. The dose also certainly requires to be considerably increased on each successive occasion. Sometimes this medicine produces a great depression of the spirits. Dr. Todd believes that Colchicum has often a tendency to change the common acute form of Gout into an asthenic form which is less amenable to treatment. So that, altogether, it is perhaps a good rule to treat the patient without Colchicum as long as it can be done with safety, adopting this medicine only as a last resource, when other remedies have been tried and failed. It ought rarely to be used in Rheumatism. In the asthenic form of Gout, or in old chronic cases, when there are chalk-stones on the knuckles, Quinine, Stimulants, and Purgatives, constitute the best treatment. Alkalies and Mercurials may prove serviceable in acute cases.
But it is certain that in many cases of this painful disorder Colchicum gives immense relief; and it often seems to be the only medicine that is capable of doing so. (Vide pp. 194, 247.)
ARSENIC.
Class I. Div. II. Ord. VI. Antiphriodica.
Class I. Div. II. Ord. VII. Anticonvulsiva.