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].
SECT. XLIV.—ON ILEUS.
Iliac passion, being a very acute and painful complaint, has a symptom more grievous even than dangerous; for those who are overpowered by the disease die a most piteous death, vomiting up fæces at last by the mouth. The affection arises from indigestion and obstruction, when the corrupted matters are retained, and from deleterious medicines, and from a falling down of the bowels into the scrotum, and from inflammation of the intestines, commonly supervening upon a colic affection. Wherefore children are to be cured by embrocations, cataplasms, clysters, suppositories, and fomentations, as described when treating of colic. But young persons and adults are to be bled without delay, and the operation repeated; and dry cupping is to be freely applied along the abdomen, and cupping even with scarifications to the affected parts. The extremities are to be rubbed and ligatures applied round them; and we must have recourse to the most drastic clysters and enemata, putting the patients into hip-baths of hot oil, giving antidotes, and purgatives; and simply all things, in short, which are applicable for colics, except when the affection of the colon proceeds from acrid and pungent humours. It has a wonderful effect in this complaint to drink the decoction of dill, even if it should be vomited up; but after drinking it, dip bread in warm water, and give the hot pieces of it to eat. For those who cannot retain their food, triturate sumach and cumin together, and give to drink in oxymel to the amount of six cupfuls. Those who are attacked with ileus from taking deleterious substances are to be compelled to vomit by drinking warm water (the symptoms arising from taking any of the deleterious substances are detailed in the [Fifth Book]); and then they are to be made to drink warm oil, or fat soups, that they may again vomit; but, after a certain number of days, they must drink the theriac. If the constipation continue, the belly is to be evacuated by curds and whey (schiston), with a little scammony, aloes, or some other purgative. If the complaint arise from the falling down of the intestine into the scrotum, we must put the patient into a reclining position with his feet elevated, and then we are to press the prolapsed intestine up to the groin, and retain it with a bandage.
Commentary. Consult the authors referred to in [the preceding Section].