Dr. A. T. Thompson* considers that it operates primarily on the bowels, stimulating the orifice of the common gall duct, so as to produce copious bilious evacuations; and, secondarily, on the nerves and arterial system. Dr. Robertson considers that its value as a gout medicine is unquestionably owing to a specific action upon the fibrous tissues. The following explanation is that of a writer in the " Medico-Chirurgical Review" (Jan. 1846). The primary effects of Colchicum, observes this writer, seem to be exerted upon the mucous surface of the bowels and stomach, stimulating their secretion, and powerfully affecting their nerves (in a manner similar to that of Veratria upon the skin). Its secondary effects are directed more immediately upun the kidneys, exciting them to a more active elimination of Lithic Acid, and probably, too, of other nitrogenized elements. The action of the remedy is, therefore, twofold: first, on those organs engaged in what Dr. Prout has called the process of primary assimilation; and afterwards on those engaged in the process of secondary assimilation. Dr. Garrod, on tl>e other hand, asserts that it possesses a power of controlling the pain and inflammation in gout, independent of all evident increase of the secretions.

Contra-Indications. 1. A great amount of debility. 2. Profuse Diarrhoea. 3. Asthenic form of Gout. Rules for Administration, See those of Dr. Todd, in section Gout.

920. Therapeutic Uses

In Gout and Rheumatic Gout, the beneficial effects of Colchicum are established beyond question; but the mode in which it is best given, the period best suited for its administration, and the cases for which it is suited, are points which demand serious consideration. It is by no means a remedy to be given indiscriminately; nor one which, in all cases, will produce equally beneficial effects. Dr. Todd's rules, given below, are judicious and practical: -

1. Colchicum Should Never Be Given In The Asthenic Form Of Gout

2. It should never be given at the outset of a paroxysm; nor until the bowels have been duly acted on by mild purgatives.

3. The first doses of the medicine should always be small; they may be gradually increased.

4. It should always be administered at first uncombined with other medicines, until the practitioner has satisfied himself that it is not likely to disagree with the patient.

5. It should not be administered so as to excite nausea,

* Cyc. Pract. Med., vol. i. p. 370. Treatise on Gout.

Essentials of Mat. Med. and Thc-rap., p. 311.

vomiting, or purging. These effects should be regarded as indicative of the unfavourable operation of the medicine.

6. It may be regarded as acting favourably, when, under its use, the urine is increased in quantity; an abundant supply of bile is discharged; when the faeces, though solid, are surrounded by mucus; and when the skin secretes freely.

7. Its Effects Should Be Carefully Wached, As It Is Apt To Accumulate In The System

In fine, the use of Colchicum seems chiefly applicable to the sthenic form of Gout, which occurs in robust constitutions, and in the prime of life; but it is almost inadmissible in persons advanced in years, who have had several attacks, and in whom the malady seems to be too deeply rooted to be influenced by the temporary administration of this remedy.

To the above excellent rules, the following observations may be appended: -

1. It is necessary to continue the use of Colchicum for many days after the entire cessation of the symptoms; the doses, however, may be diminished, and the intervals between them lengthened. (Dr. Budd.*)

2. In common cases of Gout in the extremities, Colchicum should not be used at first, but should be deferred a day or two until the malady has fixed itself. (Sir II. Halford.)

3. Alterative doses of Colchicum (doses, that is, which produce the desired purpose gradually and by insensible operation) given during the intervals of the paroxysms, may probably avert many a fit of the Gout (Dr. Watson. )

4. If the stomach be very irritable, Colchicum is best given in an effervescing draught, with an excess of alkali.

5. When Colchicum cannot be administered internally, on account of producing constitutional disturbance, it may be applied externally to the painful parts. In this way it will relieve 9 cases out of every 10. (Dr. Laycock§; and Mr. Wandsborough.||)

The extent to which Colchicum should be carried has been the source of much difference of opinion. Dr. Elliotson¶ says, that it is comparatively of little use unless it cause vomiting and purging; an opinion which is also held by Drs. Sutton, Chris-tison, Mr. Wigan of Brighton, and others. On the other hand, Drs. Gairdner, Todd, Robertson, Barlow, and other eminent authorities, consider that the operation of Colchicum is most certain when these derangements are absent. On this point Dr. Barlow ** observes, " If we have had a difficulty in exhibiting Colchicum, it arose from its too great readiness to purge, and the consequent necessity of relinquishing it. Much more benefit is to be derived from its sedative than its evacuant operation; the latter can be supplied by other and better means; in the former it possesses advantages peculiarly its own." The weight of evidence is decidedly in favour of the opinion expressed by Dr. Barlow; notwithstanding which, there can be no doubt that Sir C. Scudamore's formula is one which has been productive of great benefit: -7 Its Effects Should Be Carefully Wached As It Is  65 Magnes. Sulph. 3j. - 3ij., Acet. Colchici (Ph. Lond.) f3j. - f3ij., Magnes. Carb. gr. xv. - xx., Aquae fiss. M., ft haust. This draught is to be repeated every four, six, or eight hours, according to the urgency of the symptoms, and the extent of its operation.

*Library of Medicine, vol. v. p. 223.

Loc. cit.

Lectures, vol. ii. p. 701.

§ Medico-Chir. Rev., No. lxi. p. 190.

|| Lancet, July 29, 1837. ¶ Lectures, p. 1017. ** Cyc. Pract. Med , vol. ii. p. 372.

921. In Acute Rheumatism, Colchicum is a remedy of great value It is particularly useful in the synovial form of the disease. The bowels having been cleared out by a brisk purgative, and, if the urgency of the symptoms require it, blood having been abstracted, the following formula of Dr. Barlow * has been found of eminent service: -7 Its Effects Should Be Carefully Wached As It Is  66 Liq. Amnion. Acet. (Ph. Lond.), Mist. Camph. aa fss., Vin. Sem. Colchici, Vin. Ant. Tart, aa exx., Syr. Aurant. f3j., M. ft. haust. 4tis vel 6tis horis sumend. Dr. Budd and Dr. R. B. Todd J consider that the virtues of Colchicum in Rheumatism have been greatly overrated; indeed, the latter considers that it has a prejudicial influence on the nervous system. I have, however, never seen any ill consequences follow its use, and have too often witnessed its beneficial operation not to advise its use in the majority of cases, particularly when administered in the manner advised by Dr. Hope (see Calomel). At the same time it must be admitted, that when the disease assumes more of a fibrous than a synovial character, Colchicum often disappoints our expectations. The rules for its administration are those already laid down in Gout. Dr. Laycock § strongly advocates its external application.

Colchicum should be discontinued if there be - 1, a cessation of the pain; 2, a depressed state of the nervous system; 3, purging; 4, a disappearance of the lithates in the urine. (Dr. McLeod.||) To these may be added the observations of Dr. Watson,¶ that if the Rheumatism do not give way when the bowels become affected, it is useless to push Colchicum any further.

922. In Inflammation of the Heart audits Membranes attendant on Rheumatism, Colchicum is often of decided utility, after the first violence of the attack is subdued. It has also sometimes proved adequate to the cure of the chronic form, on persevering many months in its exhibition. (Dr. Joy.**)

* Cyc. Pract. Med., art. Rheumatism.

Lib. of Medicine, vol. v p. 202. Medical Gazette, Oct. 1848.

§ Medico-Chir. Rev., No. lxi. p. 190.

|| Lond. Med. Gaz., vol. xxi. ¶ Lectures, vol. ii. p. 679. ** Lib. of Medicine, vol. iii. p. 323.

923. In Rheumatic or Arthritic Affections of the Eye, particularly Iritis, Colchicum proves signally beneficial. After reducing any excess of inflammation by leeches and strict antiphlogistic measures, Colchicum may often be relied on. It may be advantageously combined with Tincture of Hyoscyamus and other sedatives; and should be discontinued on the occurrence of purging. Mercury in these cases is inadmissible.