the best guarantee that the morbid matter removed from the joints is carried out from the circulation; - a due and timely attention to which point would probably remove from Colchicum the reproach it has incurred of producing more frequent attacks of the disease.

There still occurs the question, very important in practice, whether this specific remedy is rightly admissible at the very outset of a fit of gout; or whether some scope and time should not be given to the local form of the disease, before thus arrested. I doubt whether this question can fitly be answered by any explicit or universal rule. Something must be left to be determined by particular constitution, by the frequency of previous attacks, and by the tendency the disorder may have shown to affect particular internal organs. There are unquestionably many cases in which I consider it well to allow some time of topical inflammation to elapse, before seeking thus to repress it; and yet more, where it is desirable to use the remedy so far cautiously, as not at once to effect the change. The rules here must generally be submitted to particular instances; nor would there be advantage in seeking to give them a more definite form.

The considerations already stated, afford cause to believe that we are still only partially informed of the value of Colchicum, or the variety of the objects it is fitted to fulfil in that peculiar temperament, of which gout in the joints is the most distinct manifestation. Its efficacy, in the more obscure and irregular forms of the disorder, must be allowed as strong proof of its specific character. And as bark, by curing, associates together many intermittent affections under the presumption of a common cause, so may Colchicum furnish similar inference regarding various affections, seemingly remote in situatation and symptoms.

This method of inference, hitherto very limited in its

application, may hereafter be extended much further. It is one of singular value, as closely connecting the treatment with the theory of disease, and rendering them mutually corrective of each other. While in thus expounding the relation to a common cause, of symptoms, differing wholly in aspect and in the organs affected, it at once enlarges and simplifies our views in every part of pathology. For the connexions here are so intimate and various, that each fact well ascertained, is fruitful of results far beyond those which directly appear to the view.

I have already noticed the use of Colchicum in a class of headaches which I doubt not to be connected with the gouty habit; and my experience furnishes me with much proof of its efficacy in such cases. These, indeed, are instances where it merits a free and fair trial. Our practice has been hitherto so much at fault in certain varieties of this disorder, especially such as have a periodical character, that we are bound, for the credit of medicine, to look elsewhere than to old and inefficient means for their relief. I think it almost certain that some kinds of headache are produced by the same morbid cause in the circulation which brings on, in other persons, or at other times, true gouty affections of the joints. With due attention to the family temperament, to the individual habit, and particularly to their connexion with certain states of the urinary secretion, it is for the most part easy to discriminate them; and thus attested, Colchicum will generally be found to act as a safe and efficient remedy.*

This relation of headache to the secretion of the kidneys, is often very strikingly marked. A remarkable case has occurred to me, of a gentleman, who from about the age of forty (which Dr. Prout has well remarked to be a common period of the commencement of lithic-acid deposits), had been subject to very frequent attacks of gravel, with constant sediments of the same nature in the urine. At the age of fifty-five, when I first saw

The action of this medicine in rheumatic and other inflammations of the joints, is certainly more ambiguous than in gout; though the old epithet of Theriaca articulorum seems to have been applied under this more general view of its use. Wherever active and beneficial in such cases, and it is certainly so in many so in many a similar principle of operation may perhaps be presumed; and as respects acute rheumatism, probably with some analogous relation to the morbid matter producing the disease. In cases of this kind, where no febrile action is present, the combination of Colchicum with bark will often be found very beneficial; the latter medicine obviating any injury that might arise from the continued use of the former.

It is a question of interest regarding Colchicum, what those effects are, which contradict or check its employment; and show themselves injuriously or dangerously, when the medicine is given in excess. That they are not so well defined as might be desired, is partly owing to the causes before mentioned, viz., the frequent attribution to the remedy, of symptoms which really belong to the disease; and the actual difficulty of discrimination in many cases, even to those who have greatest experience. Other cases, however, occur, where this explanation will not apply; and where there is proof that the Colchicum itself is injurious, either from idio

him, this tendency had suddenly ceased; and he became affected by acute headaches, so severe as to produce urgent expressions of pain; and continuing, with scarcely the interruption of a single day, for five or six months. Symptoms of chronic bronchitis then supervened, with copious expectoration. The headaches were gradually relieved as this fresh disorder gained ground; but death ensued about two years afterwards, from a more active form of pulmonary disease. At the time when this case occurred to me, Colchicum was little known as a remedy, or there would have been explicit reason for employing it.

syncrasy in the patient, or from its own peculiar properties. Its influence in gout attests the amount and singularity of the latter. It cannot, from analogy, be thus efficient for good, without the power of inflicting ill; and in the nature of its alkaline ingredient, closely related to veratria, we have an explanation of its general sedative effects, as well as of the more immediate disorder of the stomach following large doses of the medicine. Though there is strong presumption that much of the specific effect of Colchicum depends on this active principle, the question still needs farther examination. Its solution might contribute greatly to render our employment of the medicine more beneficial and secure.

The proofs of injury, indeed, from wrong or excessive use, even if much more numerous than they are, ought not to affect its character as a remedy. The case is common to all other powerful agents in medicine; and further experience will teach us how to obviate these evils, or to correct any which may be inseparable from its use.

In these remarks I have treated of Colchicum generally, without reference to the several preparations now in use. Among these, I know none more certain in effect than the acetous extract, or better capable of fulfilling the peculiar purposes of the medicine.* There may be greater convenience sometimes in employing the wines of the root or seeds; but I am not aware of any superiority they possess, unless possibly it be that of more rapid action, when such is especially sought for. I have given this extract, in moderate doses, every night for three or four weeks, without a single manifestation of ill effect. Its combinations with calomel and other purgatives in the outset of an attack of gout;

* The powder of the root of Colchicum, if properly prepared and preserved, is also, I believe, a valuable form of the medicine, and deserves further trial in practice.

with morphine or other sedatives, and with occasional laxatives, in the progress of the malady;—and with alkalies and stomachic bitters in sequel to it, and for the prevention of its recurrence, -furnish us with the greater part of what is needful in this disorder, as far as medicine merely is concerned. Limiting the present remarks to one point of treatment, I do not enter on the question, discussed and disputed from an early period, regarding the use of active antiphlogistic remedies during the attack. The rules of diet and methods of life befitting the gouty habit, form another very important part of the subject; upon which, though much has been written, there yet is scope for more exact inferences, and a steadier application of these to practice.