menced, the efforts of the physician may be renewed with better prospect of success. Leeches applied to the temples, purgatives given to aid the bowels in throwing off an oppressive load of unhealthy secretions, blisters to relieve the congestion of the lungs, and diuretics to support the drooping action of the kidneys, are the measures of most importance. These, however, will be sufficiently understood by those to whom the management of fever is familiar, and the student is referred for his guidance to the rules already laid down in the early part of the volume.

CHAP. V.

COLIC AND ILEUS.

Its

General character of these diseases. Division of Colic into four species. Effects of Simple Constipation. Common or Accidental Colic. Bilious Colic Symptoms and progress of this disease. Pathological relations. Mode of its treatment. Colica Pictonum. Its symptoms and method of cure. Of Ileus. Its causes and

usual termination.

THERE is but little in the history of these affections which is interesting to the pathologist. A few observations, therefore, on their general character, causes, and methods of treatment, will include all that seems essential to be known regarding them.

Colic and ileus are to be considered as gradations of the same state of disease; viz. of a spasmodic constriction of some portion of the intestinal canal. They are equally characterized by griping pains and distension of the lower bowels, a sense of twisting or wringing round the navel, and spasmodic contractions of the abdominal muscles, with costiveness. When these symptoms continue obstinate, and when there is added to them vomiting, particularly of matters having the appearance or odour of fæces, the disease is in its highest degree, and is called ileus, or the iliac passion.

Nosologists have been at great pains to describe different varieties of colic, but they have extended them beyond all reasonable bounds. It will be found in practice, that colic

admits of a fourfold division, according to the nature of the remote cause. The first is the accidental colic, arising from some acrid ingesta, which irritate the bowels without producing diarrhoea. The second is the bilious colic, a form of disease closely allied to bilious diarrhoea and cholera, occurring along with them, principally in the autumnal months, and apparently differing from them only in some unessential features. The third is the colica pictonum, the well-known painter's colic, arising from the poison of lead. The fourth is ileus, from disorganization of the abdominal viscera, or some mechanical impediment to the due exercise of their functions.

CONSTIPATION.

The

Before entering on the consideration of colic, a few lines may be devoted to a notice of simple costiveness. symptoms which it occasions vary greatly in their character. In most cases it produces headache and giddiness. Some times we observe thoracic symptoms emanating from such a source, such as tightness across the chest, difficulty of breathing, and a hard, dry cough. These effects of constipation are probably referrible to distension of the great arch of the colon, and consequent impediment to the free motions of the diaphragm. At other times the mucous membrane of the colon and rectum chiefly suffer, and the result is piles. Occasionally the stomach is affected, when dyspepsia follows. To constitute a fit of the colic, something must be superadded to the state of costiveness. What that is, we next proceed to investigate.

I. COMMON OR ACCIDENTAL COLIC.

This disorder is frequently occasioned by cold, atmospheric vicissitudes, change of clothing, or improper articles of diet, such as acescent wines. It is usually attended with some symptoms of indigestion, and is hence called the flatulent colic, or windy spasms. The pain of which the patient complains is often very acute, but seldom permanent, and is in almost all cases relieved to a certain degree by pressure. These circumstances, joined to the natural state of the pulse, and the absence of all febrile heat of skin, constitute for the most part an obvious diagnosis between colic and enteritis, the only disease with which it is likely to be confounded. The

student, however, will bear in mind, that the causes of colic prove also in some cases those of abdominal inflammation, and he will be prepared to find the one merging occasionally in the other. He will not hesitate, therefore, to take away blood, if the severity of the attack, or the habit of the patient, lead to the probability of inflammatory action.

Under common circumstances, the treatment of this variety of colic is sufficiently simple. In many cases the spasm is relieved by a glass of warm brandy and water. A tablespoonful of the tincture of rhubarb in a glass of peppermint water is a familiar and useful remedy. Where these fail of the desired effect, an aperient draught, containing rhubarb and the aromatic confection, may with propriety be given. In severe cases it becomes necessary to exhibit active purgative medicines (especially jalap and senna) in full doses, and to promote their operation by enemata, composed of the sulphate of soda and castor oil in thin gruel. This species of colic is frequently observed in women of an hysterical habit, and the term hysteric colic has often, but unnecessarily, been applied to it.

II. BILIOUS COLIC.

This is one of the common autumnal epidemics of this country, and will generally be found to prevail after a long continuance of a hot and moist state of the air. It occurs at the same time with diarrhoea, cholera, and jaundice, and may fairly be imputed to an increased and vitiated secretion of bile. It would appear as if the bile under such circumstances wants that cathartic quality which it commonly possesses, and acquires some preternatural acrimony, which, irritating the intestinal canal, throws it into spasmodic contractions. Acrid bile, pent up in the intestines, becomes literally a poison to the system, and is the occasion of many very anomalous symptoms. An attack of this kind is usually called a fit of

the bile.

Bilious colic is ushered in with headache, loathing of food, a bitter taste in the mouth, and very often bilious vomiting; but the urgent symptoms are distension and griping pains of the bowels, pains of the loins, and obstinate costiveness, or at most tenesmus, the motions being very scanty and partly slimy. The continuance of such an irritation even for a short

time usually leads to fever; and bilious colic therefore is frequently complicated with the more general affection, bilious fever. In this particular variety of fever there is often considerable headache, for the most part referred to the occiput. The tongue is loaded, the fur upon it being often yellow, and in streaks. There is, besides, much thirst, a short dry cough, restlessness, giddiness, and exceeding languor and lassitude, amounting even to fainting, the pulse being seldom much accelerated, or the heat of skin very apparent. In irritable habits, hysterical symptoms frequently show themselves.

In this state of disease, if a discharge of fæculent bilious matter can be obtained, the symptoms generally yield; but it is often exceedingly difficult to procure evacuations of this character, on account of the irritability of the stomach. Where bilious stools are not brought away, it is common to find chocolate-coloured motions passed, often in vast quantity, reducing the patient to a state of great weakness. If by the fortunate combination of medicines, or by the efforts of nature, the irritating cause is removed, the tongue becomes clean, appetite returns, and the patient recovers strength.

Such is a brief sketch of the bilious colic, as it prevailed in London in 1821. It closely resembled that described under the same name by Sydenham, as occurring in London in 1670-71. The observations formerly made on the causes of bilious diarrhoea apply equally to this case.

In the treatment of bilious colic, the object is to free the bowels from the load which oppresses them; but the practitioner must also keep in view that irritable state of the whole tract of the alimentary canal, which is so prominent a feature in the disease. Opium at once suggests itself as a ready means of allaying this morbid irritability of the bowels; but experience will show, that though it affords relief in the first instance, its exhibition is in most cases succeeded by increased feverishness, and an aggravation of headache, and uneasiness of the bowels.

Unless full vomiting has already taken place, it will be advisable to begin by giving ten or fifteen grains of ipecacuanha, which may be followed by a pill containing calomel and rhubarb, a dose of castor oil, or the common senna draught. If there be much irritability of stomach, it is better to commence

with a saline medicine, in a state of effervescence, containing a few drops of laudanum. This will enable the practitioner to administer his aperient subsequently with more advantage. When the operation of the purgative upon the bowels is manifest by the appearance and odour of the evacuations, a full dose of laudanum may be given with the best effect. For several days afterwards it becomes necessary to exhibit, occasionally, some gentle aperient, which may prevent accumulation and reaction. During the convalescence, which is sometimes very tedious, advantage will be derived from a light tonic, such as equal parts of camphor mixture and decoction of bark.

III. COLICA FICTONUM.

was first called

There is a species of colic which has been proved by ample evidence to arise from the gradual absorption of lead into the system. Little mention is made of such a disease in the writings of the ancient authors, though many of them were sensible of the generally deleterious effects of lead upon the body. Paulus Ægineta is the first who distinctly describes the disease, without however being aware of its true cause. For many years afterwards it was attributed to acidity. It colica pictonum by Francis Citois, in 1617. The discovery of its real source was made by some German physicians in 1696, who in attempting to investigate the origin of an epidemic colic then prevailing, ascertained that vintners had been in the habit of making their wines palatable by throwing litharge into the casks. The first author who drew the attention of the profession to the subject in this country was Sir George Baker, who in the most elaborate manner* traced the disease to lead, in a variety of situations where it had not previously been suspected.

This complaint has little to distinguish it from the more common varieties of colic. There is the same violent and almost constant pain about the navel, with a retraction of the integuments of the abdomen towards the spine, pain in the small of the back, tenesmus, and sometimes, though not constantly, vomiting. The patient experiences a degree of relief by keeping the trunk bent upon the knees. The constitution suffers but little, even in aggravated cases of this affection. The pulse

Transactions of the London College of Physicians, vols. i. and ii. 1767. A series of six papers.