There are one or two distinguishing points which help you to choose between Colocynth and Mag-phos. With Colocynth in the attacks of colic you always find the patient intensely irritable. He is frightfully impatient wants something done at once wants immediate relief, and is liable to be violently angry if the relief is not forthcoming. In Mag-phos there is not the same degree of irritability and the patient is distraught because of the intensity of the pain rather than violently angry.
Another point that sometimes helps in your selection is that Colocynth tends to have a slightly coated tongue, particularly if it is in the digestive tract that is upset whereas when mag-phos is indicated it usually is clean.
Both these drugs have a marked aggravation from cold a little more marked in Mag-phos than in colocynth. For instance, Mag-phos is exceedingly sensitive to a draught on the area whereas colocynth though it likes hot applications, is not so extremely sensitive to cold air in its neighbourhood.
Another distinguishing point between the two is that in Colocynth there is apt to be a tendency to giddiness, particularly on turning more especially to the left but this is not present in Mag-phos.
Where distinguishing point between the two is that in Colocynth there is apt to be a tendency to giddiness, particularly on turning more especially to the left but this is not present in Mag-phos.
Where you have a report that the colic and I think this applies much more commonly to uterine than to intestinal colic has followed on an attack of anger it is almost certainly Colocynth you require.
If the colic is the result of over-indulgence in cheese it is Colocynth that is indicated not mag-phos. It the pain is the result of exposure to cold either a dysmenorrhoea or an abdominal colic, it is much more likely to be mag-phos than Colocynth.
These are two of the most useful drugs in the Materia medica for colics, and it is surprising the relief you can get, even in cases of intestinal obstruction from the administration of Colocynth or Mag-phos I have seen cases of intestinal carcinoma with partial obstruction in which the patients were suffering from intense recurring colicky pains coming to a head and then subsiding mag-phos has give the most astonishing relief. Less commonly in such cases where there has been marked irritability in addition to the local symptoms Colocynth has also done wonders. Very often one or other of these drugs has kept a patient in a surprising degree of comfort till death supervened. In these malignant colic I never go high a 30th potency is sufficient. In an ordinary acute colic say dysmenorrhoea, I give a 10 M and the relief is almost immediate and the same applies to intestinal colics.
There is another drug which is very useful as a contrast to these two and it has very much the same sort of pain a very violent spasmodic colic coming on quite suddenly rising up to head then subsiding and that is Dioscorea.
Dioscorea has the same relief from applied heat and it is sometimes more comfortable for firm pressure but in contra-distinction to the other two drugs instead of the patients being doubled up with pain they are hyper-extended you find them bending back as far as possible. And the only drug I know which has that violent abdominal colic which does get relief from extreme extension is Dioscorea. I have seen it useful in gall- bladder attacks in a few intestinal colics and in a case of violent dysmenorrhoea. I have never tried it in a renal case. Where you get that extreme extension of the spine you can give Dioscorea every time without asking any further questions.
There is one other drug I want to mention because one tends to forget it as a colic medicine, and that is Ipecacuanha. Ipecac is one of the most useful colic drugs we have, and the indications for it are very clear and definite.
The character of the pain described in Ipecac. is much more cutting tan the acute spasmodic pain occurring in most other drugs. But the outstanding feature of Ipecac. is the feeling of intense nausea which develops with each spasm of pain. Accompanying that nausea is the other Ipecac. Characteristic that in spite of that feeling of deathly sickness the patient has a clean tongue. You will see quite a number of adolescent girls who get most violent dysmenorrhoea, they are rather warm-blooded people and with the spasm of pain they very often describe it as cutting pain in the lower abdomen they get hot and sweaty and deadly sick so that they cannot stand up and any movement makes them worse. They have a perfectly clean tongue and a normal temperature and very often Ipecac will stop the attack and even the tendency to dysmenorrhoea altogether. It is one of the very useful drugs and as I say one of the ones one tends to overlook.
I have seen several cases of renal colic, associated with the same intense nausea, which have responded to Ipecac., but I think that is more rare it is more commonly in uterine cases that you get indications for it.
There are three drugs I always tend to associate in my own mind for colic; Lycopodium Raphanus and Opium the reason being that in all three the colic is accompanied by violent abdominal flatulence. It is always an intestinal colic in which I expect to find indications for one or other of these drugs. It may be associated with a gall-bladder disturbance of the other two.
In all three there is a tendency for the flatulence to be stuck in various pockets in the abdomen that is to say, you get irregular areas of distension. In all three you are likely to get indications of the bowel. Where you have definite paralytic conditions like a paralytic ileus following abdominal section you are more likely to get indications for Raphanus and opium than for Lycopodium but if the paralytic condition happens to be more in the region of the caecum the indications are probably for Lycopodium rather than for the other two.
That is the general picture and there are one or two distinguishing points which help you. For instance, in Lycopodium the colicky pain is likely to start on the right side of the abdomen down towards the right iliac fossa and spread over to the left side, whereas in the other two it remains more or less localised in the one definite area.
In Lycopodium you are very liable to get a late afternoon period of extreme distress, the ordinary 4 to 8 p.m. aggravation of Lycopodium. There is likely to be very much ore rumbling and gurgling in the abdomen in Lycopodium, and there is more tendency to eructation whereas in the other two the patient does not seem to get the wind up to the same extent. Where there is eructation the patient usually complain of a very sour taste in Lycopodium cases.
In Lycopodium you usually have a somewhat emaciated patient with a rather sallow pale complexion.
There are one or two points that lead you to opium instead of the other two. In opium, as I said, there is apt to be a definite area of distension and the patient may say that he gets a feeling as if everything simply churned up to one point and could not get past it, or as if something were trying to squeeze the intestinal contents past some obstructing band or as if something were being forced through a very narrow opening.
Another point that leads to the selection of opium is that with these attacks of colic the Opium patient tends to become very flushed and hot feels the bed abominably hot wants to push the blankets off, and after the spasm has subsided tends to become very pale limp and often stuporous.
The area of distension in Opium is likely to be in the centre of th abdomen rather than in the right iliac fossa, and it is one of the most commonly indicated drugs in a paralytic ileus.
Another point that sometimes puts you on to Opium is that when the pains are developing and coming up to a head the opium patients develop an extreme hyperaesthesia to noise. I remember one patient who had a paralytic ileus after an abdominal section and as he was working up to another attack of vomiting he had that hyperaesthesia to noise more marked than I have ever seen it. If the nurse in the room happened to jangle the basin into which he was going to be sick he nearly went off his head and he turned and fairly cursed her. That hyperaesthesia to noise make me think of Opium and it completely controlled his attack and the whole condition subsided. This hyperaesthesia is worth remembering as it is so different from the sluggish condition induced by the administration of Opium in material doses.
The Raphanus type of post-operative colic is again slightly different. Instead of getting the right side of the abdomen distended as in Lycopodium or the swelling up in the middle as in Opium in Raphanus you gets get pocket of wind a small area coming up in one place getting quite hard and then subsiding. followed by fresh areas doing exactly the same.
These pockets of wind may be in any part of the abdomen. In the acute attacks of pain the patients tend to get a little flushed but not so flushed as the Opium patients and they do not they the tendency to eructation that one associates with Lycopodium in fact they do not seem to be able to get to rid of their wind at all either upwards or downwards. But it is these small isolated pockets coming up in irregular areas throughout the abdomen which give you your main lead in Raphanus cases and I have seen quite a number of them now, post-operative cases and it is astonishing how quickly after a dose of this remedy the disturbance subsides and the patient begins to pass flatulence quite comfortably.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.