SOME EMERGENCIES OF GENERAL PRACTICE



In a Berberis renal case the urine is as a rule rather suggestive. More commonly it is not blood-stained, but contains a quantity of greyish-white deposit which may be pure pus, but mostly contains pus and a quantity of amorphous material usually phosphates, sometimes urates. Although it is a very dirty looking urine it is surprisingly inoffensive.

There are two drugs drugs which one always thinks of for colics of any kind, and they are COLOCYNTH and MAG. PHOS. It does not matter where the colic is; when you have an acute abdominal colic of any kind one always thinks of the possibility of either Colocynth or Mag. phos. Both remedies are often useful for colic in any area, uterine, intestinal, bile ducts, or renal-it does not matter which it is. The point about these drugs is the they are almost identical, that always in their colics the pain is very extreme, and the patients are doubled up with pain. In both cases the pains are relieved by external pressure, and by heat. In Mag. phos. there is rather more relief from rubbing than there is in Colocynth, which prefers steady, hard pressure.

The next thing about them is that their colics are intermitting. The patients get spasms of pain which come up to a head and then subside.

There are one or two distinguishing which help you to choose between Colocynth and Mag. phos. With Colocynth, in the attacks of colic you always find the 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 the digestive tract 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 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 indicated, not Mag. Phos. If 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 pain coming to a head and then subsiding, where Mag. Phos. has given the most astonishing relief. Less commonly kin 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 colics I never go high: a 30th potency is sufficient. In an ordinary acute colic, say dysmenorrhoea, I give a 10m 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 a 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 contradistinction 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 extention is Dioscorea. I have been is useful in gallbladder 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 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 than 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 spasms 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 spasms 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 colics. Lycopodium, Raphanus, and Opium, the reason being that in all three the colic is accompanied by violent abdominal flatulence. It is always in intestinal colic in which I expect to find indications for one or other of these drugs. It may be associated with a gallbladder disturbance, and if so it is much more likely to be Lycopodium than either 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 in post-operative abdominal distensions, semi- paralytic conditions of the bowel. Where you have definite paralytic conditions like paralytic ileus following abdominal section you are more likely to get indication for Raphanus and Opium than for Lycopodium, but if the paralytic condition happens to be ore 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 none 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 localized 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 more rumbling and gurgling in the abdomen in Lycopodium, and there is more tendency to eructation, whereas in the other two the patients does not seem to get the wind up to the same extent. Where there is eructation the patients 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 tow. In Opium. as I said, there is apt to be a definite area of distention, 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 stuporose.

The area of distension in Opium is likely to be in the centre of the 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 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.

Douglas Borland
Douglas Borland M.D. was a leading British homeopath in the early 1900s. In 1908, he studied with Kent in Chicago, and was known to be one of those from England who brought Kentian homeopathy back to his motherland.
He wrote a number of books: Children's Types, Digestive Drugs, Pneumonias
Douglas Borland died November 29, 1960.