SECT. XLIII.—ON COLIC AFFECTION.
The colon, being a part of the large intestine, takes its origin in the right iliac region, and passes across to the left, in the form of a belt. The most violent pains arise in it from various causes, either from a thick and pituitous humour shut up between its coats, or from a thick flatus that cannot find a passage out, or from inflammation of the intestine, or from acrid and sharp humours. Those, therefore, who suffer from a thick and pituitous humour, have a deep-seated pain along the whole abdomen, and especially in the region of the colon; there is a sensation as if it were pierced by a wimble; they are troubled with tormina, eructations, nausea, and vomitings of all kinds, but more especially of phlegm. The belly is greatly constipated, so as not to allow the passage even of wind; and any fæces which are discharged seem like the dung of oxen, light and windy. These symptoms are usually preceded by the continued use of food of a cold and incrassating nature, repletion, indigestion, inactivity, and the like. When the attack proceeds from flatulence, there is rather a sense of distension. When it is from inflammation, there is a sense of heat in the part, and no inconsiderable fever, retention of the urine as well as of the fæces, pulsation in the belly, thirst, and troublesome heat, nausea, and vomitings, more especially of bile, which afford no relief. In short, this is the most severe of the colic affections, and threatens to pass into ileus. When acrid and sharp humours are the cause of the pain, the patients, as in the case of inflammation, have heat, thirst, and sleeplessness; if they have fever, it is less than in the former case; their urine is acrid; the alvine discharges bilious; and often along with the discharge from the bowels the pain is aggravated, and exacerbations thereof take place, more especially after heating food or drink. Pains occasioned by cold, viscid, and thick humours are to be cured by such things as are not violently heating; for by things which are thus heating the humours are dissolved and converted into air. Wherefore we must try to incide and concoct them by carminatives, and such medicines as are attenuant and desiccant, without heating much at the beginning of the complaint. The fæces being evacuated from the bowels by suitable clysters, we must use an injection of oil, in which cumin or rue has been boiled, with the grease of a goose or hen; or of a decoction from the roots of wild cucumber, with a drachm of myrrh and some honey and oil; or from myrrh, honey, and Sicyonian oil. And often, when common oil is injected, the vitreous phlegm is discharged along with it, and instantly removes the pain. If, owing to the violence of the pain, the injection be retained, we must apply a suppository of honey, cumin, nitre, and the dried seeds of rue; or of a stalk of cabbage well shaven down and macerated in salt water; or of the ashes of cabbage mixed with honey; or of colocynth triturated with honey, nitre, and cumin. The suppositories should be six fingers’ breadth in length, so that they may extend beyond the sphincter muscle. The anus is to be anointed with the juice of sow-bread, with honey and nitre, or with centaury along with honey and nitre. When the pain is continued, in addition to the afore-mentioned, these injections are to be used: Of turpentine-rosin, oz. j; or of opopanax, dr. i; or of galbanum, dr. iv; of bitumen, an equal part, with, of nitre, dr. j; and of water, oz. j; of oil of rue, oz. v, or more. Embrocations are to be applied to the affected parts from the oil of cumin, of dill, or Sicyonian oil. Cataplasms are to be applied, composed of the medicine called trispermum with cumin, bay-berries, and parsley-seed. Epithemes are to be applied, namely, that from seeds, that from bay-berries, that from meliot, and the polyarchian. Let the patients sit in a hip-bath of the decoction of fenugreek, marshmallows, chamomile, mugwort, dill, bay, and the like. And they may be made to sit in a hip-bath of warm oil, or in oil and water. They should take potions containing wormwood and cumin, in equal parts, or panacea with water, or of castor, of anise, and of the peppers, dr. j, with oxymel. When the pain does not remit, we must give them a draught, containing the medicine from three peppers, or the theriac; and have recourse to a sinapism and dropax during the remissions, and to the natural baths; but they must abstain from bathing in drinkable water, unless compelled to have recourse to them by the urgency of the pain; when, having previously injected some of the afore-mentioned medicines, we must direct them to bathe, and be fomented within the heated walls of the bath, having been previously rubbed with some of the detergent ointments containing nitre. When the pain is violent, we must use those things which are moderately soothing, such as the trochisk of castor, either injected or taken by the mouth, and such like remedies. But powerful narcotics must be avoided, which allay the pain indeed for a short time, but render the affection more protracted by incrassating the offending matter, and occasioning obstruction of the pores of the intestine. When the phlegm is attenuated, we must purge them with hiera picra, or such pills as these: Of aloes, of euphorbium, of pure granum cnidium, of scammony, equal parts. The dose is two scruples. A heating and desiccant diet will suit with them. At first, indeed, they should abstain from food, but afterwards take acrid food. Wherefore we must give them leeks boiled with prepared wine and parsley, and marsh asparagus, raw garlic, more especially if they do not dislike these things; and they may drink of the prepared wine, and take some bread with it. Afterwards we must give them wholesome and digestible food, avoiding a surfeit and indigestion. If it is a flatulent spirit which causes the pain, after carminative injections and draughts, dry-cupping by means of large cupping-instruments, heated and fixed along the whole abdomen, often effects a cure. When the intestine is in a state of inflammation, we must bleed from the arm; but if dysuria prevails, we must likewise open the vein in the ankle, and use the remedies already mentioned, except those things which are acrid and powerfully cathartic; and we must rather use soothing injections, cataplasms, fomentations, placing the patient in a hip-bath of oil. We may also apply cupping-instruments to them, and lay a cerate upon the abdomen, containing, of wax, oz. v; of chamomile, oz. ij; of rose-oil, oz. ij; of the flour of beans, oz. ss; five yelks of eggs pounded with the juice of linseed. The diet should be light, and such as that applicable in fever, until the inflammation be resolved. But if the pain arise from acrid and sharp humours, we must administer injections of oil, in which has been boiled fenugreek or marshmallows, with plain fresh grease of a goose or hen, or the juice of ptisan with rose-oil, or the juice of linseed. They must take the antidote called picra from aloes in a draught, and use baths of sweet waters, and spoon-meats from chondrus or ptisan, and fishes caught among rocks; and, in a word, the whole regimen should be moistening and cooling. The patient must abstain from all acrid food and medicines, and from hot fomentations, by means of embrocations and cataplasms, and from drinking wine, more especially old. When the pain is strong, we may also use narcotics; for they prove less injurious in this case than in any of the others, incrassating and moderately cooling the thin and sharp humours. I am of opinion that the colic affection which now prevails is occasioned by such humours; the disease having taken its rise in the country of Italy, but raging also in many other regions of the Roman empire, like a pestilential contagion, which in many cases terminates in epilepsy, but in others in paralysis of the extremities, while the sensibility of them is preserved, and sometimes both these affections attacking together. And of those who fell into epilepsy the greater number died; but of the paralytics the most recovered, as their complaint proved a critical metastasis of the cause of the disorder. Those, therefore, who were thus affected, a certain physician in Italy cured, in an incredible way, by putting them boldly upon a refrigerant diet. For he gave them unboiled lettuces previously cooled, and succory, in like manner, to eat until they were more than sated; and also grapes, apples, fish which have hard flesh, and, in short, all the crustacea; also the feet of oxen, the bulbi, and the like, namely, things which were not only cold by their powers, but likewise to the touch. He seldom gave wine, and when he did, he mixed it with cold water. And he gave cold water for drink, or cold oxycrate, and prohibited all warm food and that of the middle kind; and, contrary to all expectation, he cured most people in this way, and even some who had begun to experience a conversion of the disease into epilepsy or paralysis.
Commentary. See Hippocrates (de Affect. xv); Galen (de Med. sec. loc. ix; de Loc. Affect. vi, 2); Aretæus (Morb. Acut. ii, 6; Chron. ii, 8); Alexander (ix, 1); Celsus (iv, 14); Oribasius (Loc. Affect. Curat. iv, 87); Leo (v, 13); Aëtius (ix, 29); Actuarius (Meth. Med. i, 45); Pliny (H. N. ix, 37); Nonnus (170); Scribonius Largus; Cælius Aurelianus (Tard. Pass. iv, 7); Marcellus (de Med. 29); Serapion (iii, 32); Avicenna (iii, 16, 4); Avenzoar (ii, 1); Haly Abbas (Pract. vii, 28); Alsaharavius (Pract. xvii, 2, 12); Rhases (Divis. 69; Contin. xxi.)
Hippocrates treats very sensibly of the colic pains which occur in summer, recommending for them emetics of tepid mulse and vinegar, warm clysters, the warm bath, fomentations, soporifics, and purgatives, according to circumstances. When the pains are seated in the lower part of the belly, he merely gives clysters and laxatives.
Galen gives a long list of preparations for colic. They consist principally of narcotics, such as opium, henbane, and mandragora, along with carminatives and aromatics, as anise, pepper, valerian, cinnamon, saffron, gentian, and the like.
Aretæus concludes his chapter on ileus with a short account of colic. He remarks that the colon being a larger and more fleshy intestine than the ileum, the pain is less acute, and the complaint in so far less dangerous. The pain, he says, sometimes extends to the side, resembling pleurisy; sometimes to the false ribs, resembling hepatitis or splenitis; and sometimes to the os sacrum, tops of the thighs, and testicles. The complaint is attended with unavailing vomiting; and what is vomited is thin, bilious, and oily. He also describes a more protracted species of colic among the chronic diseases. Among the symptoms he enumerates torpor, loathing of food, watchfulness, and swelling of the face. He says the pain sometimes shoots down to the testicles, whereby ignorant surgeons have been led into the mistake of supposing that the disease was seated there, and have made an incision into the cremasters. Does he allude to the operation for strangulated hernia? or does he mean to say that the disease is confounded with inflammation of the testicle? His treatment of ileus will be given in [the next Section].
Alexander insists strongly on the absolute necessity of distinguishing colic from the diseases of the adjoining parts, which, he remarks, is sometimes difficult. He first treats of colic pain arising from a cold humour, and discusses fully the remedies for it. They are nearly such as our author recommends, namely, attenuant food, including white wines in cases of flatulence; avoiding the common bath, which does no good, but using the sulphureous bath if convenient; rubbing the affected parts with calefacient ointments, or applying heated bricks to them; purging with aloes, scammony, and the like; using the hip-bath made with the decoctions of parsley and anise, common oil, and the like; applying epithemes; administering clysters of hot oil, either alone or with some carminative, such as turpentine; giving narcotics, as opium and henbane, when the humours are thin and acrid, but not otherwise; applying sinapisms and calefacient plasters; sometimes giving emetics; and in protracted cases enjoining exercise. When the disease proceeds from flatulence, he applies dry fomentations of millet, calefacient oils, and a cupping-instrument to the belly. When it is occasioned by constipation, he directs us to remove the obstruction by giving water, oil, and mead, and administering the same in clysters. In obstinate cases he directs us to inflate the bowels with a bellows, and afterwards to inject a little nitre and oil and water. He also speaks of pills or pellets of lead. When it proceeds from hot and bilious humours, he gives for food fish, the testacea, the most indigestible parts of quadrupeds; and recommends the common bath, and purging with drastic cathartics, such as hellebore and scammony. When inflammation is the cause, he forbids purgatives, because they only increase the evil, but recommends general bleeding repeated at intervals; and, if the urine is suppressed, bleeding at the ankles; also emollient clysters, external applications of a soothing nature, and baths after venesection, but not before.
Celsus recommends principally dry fomentations, friction of the extremities, and dry cupping. He also mentions a medicine called the colic composition, consisting of poppy tears, pepper, anise, castor, spikenard, myrrh, &c.
The beginning of Cælius Aurelianus’s chapter on colic is unfortunately lost. He approves of venesection, fomentations of sweet oil, and injections of the same; but disapproves of adding rue, anise, or anything calefacient to them; speaks favorably of cupping and leeching, which are to be followed by hot fomentations with sponges squeezed out of warm water, or by the hip-bath. As to the calefacient and acrid things usually given, namely, parsley, cumin, and the like, he properly directs them to be avoided when inflammation is present. In this case he recommends the bath of oil. When the complaint is on the decline, he approves of gestation, of friction of the belly with rubefacients; and of sinapisms, calefacient plasters, and the like. He speaks favorably of a long sea-voyage, and of the use of medicinal springs, especially sulphureous, and directs indigestion and everything of a flatulent nature to be guarded against.
Several of the other Greek and Latin authorities, especially Aëtius, treat of colic with admirable precision; but, as their remedial measures are much the same as those already mentioned, we shall not attempt to give any account of them.
Serapion’s divisions and treatment are nearly the same as our author’s. Avicenna, however, treats of the complaint more fully and circumstantially than any other ancient author, but the length of his description prevents us from giving an abstract of it. We may mention, however, that when the pain is violent he approves of narcotics both by the mouth and in clysters. Among the causes of colic mentioned by Haly Abbas is debility of the intestine, so that it can neither digest the food nor evacuate it. Haly justly remarks that the inflammatory colic is the worst species of the disease, for that in it the patient experiences no relief from evacuations, and the danger is imminent. With regard to the treatment of it, he forbids purgatives, which do but increase the irritation; and recommends bleeding, emollient drinks, plasters, &c. In flatulent colic his remedies are purgatives and carminatives, such as hiera with anise, fenugreek, cucumber, mastich, &c. In all cases he approves much of clysters. Alsaharavius enumerates the following causes of colic: A hot intemperament, hernia, indurated fæces, cold humours impacted in the intestines, and the presence of some poisonous medicine. We dare scarcely venture upon an exposition of the minutiæ of his treatment. When the disease is occasioned by retention of hard fæces, he recommends oily injections, baths, and diluent draughts. When it arises from gross humours, he agrees with Galen in approving of strong wine, clysters of dill, chamomile, fenugreek, and the like, boiled in water. Rhases directs us to give emetics when the disease arises from indigestion. He probably alludes to duodenal disease. He mentions alvine calculi and worms among the causes of colic. He particularly recommends the warm bath and clysters.
Our author’s interesting account of the epidemical colic is copied by Avicenna; but neither he nor any other subsequent authority supplies the smallest additional information. Pliny seems to allude to an epidemical colic which prevailed in the reign of Tiberius, but gives no satisfactory account of it. (H.N. xxvi, 6.) The Jewish physician Moyses Alatinus gives the following description of a pestilential colic resembling that described by Paulus and Avicenna: “Colicam, iliacamque, hujus generis, contagiosas passiones, quas hoc in loco refert Avicenna, memini me olim vidisse in civitate Mantuæ anno 1560, mensibus nimirum Augusti et Septembris, quia publicè tunc temporis ejusmodi passiones contagiosæ per universam civitatem grassabantur, cum sævis symptomatibus, assiduo nempe, ac urgente vomitu bilis porraceæ in magna copia, nec non etiam æruginosæ, lipothymia, assiduâ febre malignitatis non experte, ac siti immensâ, ac in eâdem familiâ plurimi eo morbo oppressi inveniebantur,” &c. (Marciæ Prælect. 276.) See [Book Second, Sect. XXXVI].