Whatever be its mode of action, colchicum still remains par excellence the remedy for acute gout. As before noted, Dixon and Maiden hold that colchicine has no action on the metabolism or excretion of purins, nor on the kidneys. On the other hand, it influences markedly the leucocytes, their number in the circulation undergoing a primary decrease and a secondary increase. Bain, it is true, found that under colchicum a slight increase in uric acid excretion occurred, but thinks it extremely doubtful if its influence in this direction is invariable.
That colchicine should exert such a marked effect in gout and yet apparently be destitute of any influence on uric acid excretion is of course very striking. It calls, moreover, for more reflection on the part of those who seem to contend that because a drug increases uric acid elimination it must necessarily be beneficial both for the gout as well as for the victim.
Method of Administration.—In initial attacks the drug must be exhibited with caution. Some persons are idiosyncratically sensitive thereto. Attacks of faintness may ensue, or even ordinary doses occasion purging or nausea and vomiting. Their incidence shows either that the subject is abnormally sensitive or the dose too large. Such untoward phenomena indicate its abandonment or drastic reduction. With these reservations, colchicum may be administered in every primary attack and most, if not all, of the succeeding paroxysms.
Albeit, the older the subject and the more ancient the gout, the more warily should we proceed, especially if there is marked irritability of the digestive system, renal disorder, or cardiac degeneration. Robin holds that if visceral gout is present, or the urine contains much albumen, no colchicum should be given.
It is notorious that old persons stand colchicum badly. In their instance we need be the less ready to resort to heroic doses when we recall that acute gout is a self-delimited disease, and while it would be improper to do nothing in elderly subjects exhibiting visceral lesions, etc., it is well that we proceed cautiously, so as to avoid the induction of circulatory depression or the excitation of nausea or a diarrhœa which may be, and often is, difficult of control. Moreover, if these untoward symptoms are allowed to ensue, there is a tendency for the gout to recur as soon as the effects of the colchicum have worn off.
Preparations of Colchicum and Dosage.—Those most commonly in use are the tincture and wine of colchicum, and of these the latter is most in favour. As to dosage, most authorities agree that a full dose—30-40 minims of the vinum colchici—should be given at the inception of treatment and followed by smaller amounts, from 10-20 minims two or three times a day.
By French physicians the tincture of colchicum is preferred, and by Robin that extracted from the flowers rather than the seeds. The dose of our own official Tinct. colchici seminum ranges from 5-15 minims, and by the French Codex the maximum single dose is placed at 25 minims, and the maximum intake during twenty-four hours at 100 minims approximately. It may be noted that preparations from the seeds are more purgative than those derived from the corn. Lastly, we have the official extract of colchicum and the acetic extract. The dose of the former ranges from ¼-1 grain, and it is frequently given in the form of a pill with ipecacuanha and mercury. The addition of a small dose of atropine is often advisable, to obviate the vomiting and diarrhœa often primarily induced by increase of peristalsis. By many the acetic extract is preferred, J. S. Matthews holding that the effective dose ranges from 2-6 grains.
Turning now to discuss the most opportune juncture at which to administer colchicum, certainly in the initial and the earlier paroxysms we may with advantage postpone the giving of colchicum pending free clearance of the bowels. No harm will follow its being withheld until the second day. Indeed, many physicians, both British and Continental, counsel delay in its exhibition until the fit is well established.
Again, in primary paroxysms—viz., while ignorant of the personal equation in respect of colchicum—it is well that our maximum dose should not exceed 20 minims, and when the bowels have not been previously purged, the drug should be combined with sulphate and carbonate of magnesia, as in the following prescription:—
| ℞ | Magnesii sulphatis | gr. 60 |
| Magnesii carbonatis | gr. 10 | |
| Potassii citratis | gr. 30 | |
| Vini colchici | ♏︎ 20 | |
| Aquæ menthæ viridis | ad unciam. | |
| Misce. fiat mistura. Two tablespoonfuls with two of hot water every three hours until bowels have been freely opened. | ||