Colocynthis

CUCURBITACEAE.

Cucurbitaceae: 1. Colocynthis cucumis. 2. Bryonia alba. 3. Citrullus (Water-melon)—The seeds are diuretic. 4. Cucurbita (Squash). 5. Momordica balsamum—Flatulency. 6. Elaterium momordica—Bowels and fever.

To-day we begin our study of the Cucurbitaceae. This order gives us some six or eight drugs, and also some edible substances. Among the latter are the water-melon, canteloupe, and cucumber. The seeds of some of these have diuretic properties, and those of the water-melon have been used as a cure for worms.

Of the medicinal substances obtained from this order we may say that they all act prominently on the alimentary tract. They seem to have in common a cathartic action. They probably act paralyzingly on the vaso-motor nerves of the abdomen. They produce griping pains, gushing watery diarrhoea. This last symptom is most prominent under Elaterium.

Let us now enumerate these medicines. Fifth on the list is the Momordica Balsamum; of this we have but one characteristic symptom, and that is accumulation of flatus in the splenic flexure of the colon. It is a very convenient thing to know this. For instance, if, during the course of a more or less chronic disease, this one symptom becomes very annoying, and you do not want to destroy the action of the drug you are giving, you simply interpolate a dose of Momordica, which removes the symptom and enables you to go on with the treatment as before.

Elaterium, another member of the order, has been used principally, in our school of medicine, in a peculiar form of diarrhoea. Like all the Cucurbitaceae, it acts powerfully on the alimentary tract, producing a sudden and enormous effusion of serum into the bowels. Thus it causes a watery diarrhoea, the stools flowing out very profusely. The characteristic symptom of the drug, and the one which will lead you to its selection in cholera infantum, is watery stools of an olive-green color, coming out with a gush. Thus, you see, it is comparable with Croton tiglium, Podophyllum, and Veratrum album, and remedies of that type.

It is readily distinguished from Croton tiglium, which is adapted to a profuse, yellow watery stool, which is provoked every time the patient eats or drinks.

Podophyllum has, as you all know, the morning aggravation to distinguish it.

The remaining medicines belonging to the Cucurbitaceae are the Citrullus, or water-melon; the Cucurbita, or squash, the seeds of which, as well as those of the pumpkin, have been used for taenia; the Colocynth, and the Bryonia alba; the last two named being drugs of great importance; we will therefore proceed to their consideration in extenso.

COLOCYNTHIS CUCUMIS.

Colocynthis: 1. Nerves—Neuralgia; Cramp. 2. Bowels. 3. Urine. 4. Gout.

The Colocynthis cucumis furnishes us with a gourd about the size of an orange with a smooth marbled green surface. When dried it appears of a brownish color. It is not indigenous to this country, but is imported from Syria and Turkey. Often, however, it is found in the market, pealed and dried, looking like a pithy ball, full of seeds and very light in weight. It is inodorous, but it has an intensely bitter taste.

Like the other members of this group, Colocynth causes violent intestinal irritation, first watery evacuations and later of mucus and blood. The pains are atrocious, griping, cutting, etc. But this is not all. The drug also affects the nervous system powerfully, whence comes its beneficial effects in the treatment of various neuralgias. In its neurotic symptoms, Colocynth is closely allied to Dioscorea villosa.

Furthermore, this remedy so long restricted to the relief of colic alone, has lately wrought cures in certain deep-seated ovarian diseases, as ovarian tumors. Colocynth acts directly on the ovaries, and also upon the epididymis. It is a mistake to assert, as was done formerly, that it can cause no inflammatory action; for in a case of poisoning, the autopsy revealed freshly-glued intestines, thus showing an inflammatory exudate. It is indicated in affections of the ovaries by stitching pains as from a needle deep in the right ovarian region, and crampy pains relieved by bending over or from pressure.

Two cases of ovarian tumor have been reported as cured by Colocynth on these symptoms.

I well remember having cured a lady from ovarian colic from which she had suffered for three years, with Colocynth. The pains in this case were of a griping character and were relieved by bending double. There were no organic changes present.

Now let us examine the action of Colocynth on the abdomen and its contents with the concomitant symptoms: Persistent bitter taste; violent thirst; empty eructations; nausea; vomiting of a bitter fluid or of food; griping pains which force him to bend double or to press firmly against the abdomen. This griping is the well-known key-note of the drug, and it is indicatory whether it be of local origin or reflex, whether arising from flatus, undigested food, or cold; or whether resulting from violent emotions, as in what has been termed " nervous colic." The stools may be fluid, copious, faecal, flatulent and papescent; or slimy and bloody and preceded by severe tenesmus; but in every case there is this griping which more often precedes the stool and is relieved afterwards. Sometimes, however, it continues after stool. These evacuations are provoked by the slightest food or drink, as is also the pain. In some instances the griping develops into cutting, stabbing pains, which spread all over the abdomen and down into the pelvis. They are relieved by the emission of flatus or by stool. This pressure of flatus may incommode the bladder, relief, however, instantly following borborygmi. The urine is foetid and deposits a mucous sediment.

Leaving Colocynth for a while we will now compare it with some of its concordant remedies.

In the bad effects of anger, Colocynth is closely allied to Chamomilla and Staphisagria and, more remotely, to Causticum. It resembles Chamomilla in the violence of its emotions. Both drugs may be used in children when violent emotions produce cramps and even bilious stools. Chamomilla differs from Colocynth in the violence of its congestive symptoms, hot sweat on the head, etc. The characteristic Chamomilla temperament also helps you to decide.

Staphisagria is sometimes to be substituted for Colocynth in the effects of violent emotion in women and children when the violent abdominal cramps fail to yield to that remedy.

In its abdominal and gastro-enteric symptoms you should compare it with Aconite, Veratrum album, Bovista, Croton tiglium, Elaterium, and Mercurius.

Veratrum album has abdominal pains forcing the patient to bend double, but he must walk about for relief. He also has cold sweat on the forehead. It is especially suitable in ileus or intussusception of the bowels.

The colic of Bovista finds relief from bending double after eating. The urine is red.

Croton tiglium has these pains with profuse watery diarrhoea. The stools are yellowish, brownish or green in color and profuse, coming out with a gush as water from the hydrant. They are aggravated after nursing or eating.

As shown by the symptoms, Colocynth is a remedy sometimes needed in summer complaint and in dysentery. It differs from Croton tiglium which has stools whenever the patient eats or drinks, in that these movements are profuse and watery, and gushing like water from a hydrant. Elaterium again changes the picture by producing olive-green stools, profuse and gushing. Croton tig., it is true, causes green stools, but they are a brownish green. Colocynth differs from Mercurius because the tenesmus, etc., cease after stool in the former. It differs from Nux vomica also, for though the pain ceases after stool in Nux, the movements are scanty and there is frequent ineffectual urging.

The griping already referred to, is not, in Colocynth, confined to the intestinal tract. We may confidently employ the remedy when the griping involves the bladder in some forms of strangury or of spasm of that viscus, and also in menstrual colic, whether uterine or ovarian. All that is requisite is that the nervous element shall predominate over the inflammatory, with the relief from bending double and from firm external pressure.

Transferring this " nervous action" of the drug to the "voluntary system," to the cerebro-spinal system, we find symptoms like the following: Left sided tearing crampy pains after vexation or mortified feelings; boring, tearing pains in the head, boring stitches, sharp cutting pains in the eyeballs and extending thence up into the head; worse at rest and on stooping, and better from firm pressure and from walking; eye, on stooping, feels as if it would fall out; profuse acrid tears. These symptoms suggest Colocynth as a remedy in gouty and bilious headaches, and also in the intense pains of iritis, ciliary neuralgia and glaucoma.

Here we may compare Chamomilla, Cedron, Spigelia and Prunus spinosa.

Chamomilla also has left-sided tearing headache from anger, biliousness, etc., but it has more red face, hot sweat, etc.

Cedron has periodical pains about the eyes; it is usually, however, supraorbital, and it may be of malarial origin.

Spigelia is very similar to Colocynth. The eye feels too large; the pains are stabbing, tearing and radiating; they are aggravated by pressure and motion; Colocynth finding relief by walking in a warm room, and on pressure.

Prunus spinosa has more crushing pain; a feeling as if the parts were pressed asunder.

Colocynth has proven useful in hip diseases, especially of the right side; dull stitches during walking, must stand still; followed by heaviness and sensibility of the affected parts; crampy pain as though the parts were screwed in a vise; lies on the affected side with the knee drawn up. In studying these symptoms we also see the application of the drug to sciatica; pains extending down the sciatic nerve to the knee or even to the heel, aggravated by any motion. The attacks of pain are followed by numbness of the whole limb and partial paralysis. If the case is of long continuance, the nutrition of the limb is defective. Sometimes the cramps in the leg are so severe that the patient feels as if the whole leg were fastened down by iron bands. The pains are usually worse at night.

Gnaphalium is very similar to Colocynth in sciatica. It has intense neuralgic pains along the course of the sciatic nerve, alternating with numbness.

In cramps of the muscles you should compare Colocynth, Nux vomica, Veratrum album and Cholos terrapince.

In rheumatism, Colocynth may be useful, especially for the stiffness of the joints following the acute disease.

If, however, there are concretions in the joints, you should think of Causticum and Guaiacum.

Guided by its constrictive qualities, physicians have used Colocynth in paraphimosis.

Colocynth is antidoted by Coffee, Camphor and Staphisagria.