In the continued or chronic colic the pain may persist for as long as two months, during the whole of which time the patient complains of uneasiness and even constant pain in the lower part of the abdomen, which becomes considerably worse after each evacuation, and almost invariably is associated with exceedingly obstinate constipation. It is this type of case that olive-oil or liquid paraffin relieves, while in the acuter forms drastic purgatives such as castor-oil, croton-oil, or pulv. jalapæ comp. may be administered.
For the treatment of pain in colic one of the various vaso-dilators should be used, as, in addition to the spasm of the intestine, a very considerable vaso-constriction of the whole of the vessels in the mesenteric area occurs. Amyl nitrite gives immediate relief, but the effect passes off somewhat rapidly, whilst scopolamine, although taking somewhat longer to act, is better for continuous use, as its action is longer maintained. Sodium nitrite, liquor trinitrini, and antipyrin are also of use. Atropin may be used, but it is perhaps better given in conjunction with magnesium sulphate.
Whatever form of purgative is given, some form of anodyne should be combined. Drissole and Tanquerel[3] are said to have obtained excellent results with croton-oil; one drop is given, followed seven or eight hours later by another, and then by an enema of 2 pints of normal saline. After two or three days the croton-oil may be again given, one drop at a time each day. In addition, Tanquerel made use of belladonna and opium together, finding that their combined action was better than that of opium alone, as the physiological effect of belladonna probably assists in preventing the intestinal cramp.
Hoffmann[4] recommends the use of olive-oil and opium, giving 3 to 4 ounces of olive-oil. He says that this relieves the spasm of the pylorus, and is of particular use where severe vomiting is associated with the colic. This use of olive-oil, first suggested by Hoffmann in 1760, and revived by Weill and Duplant[5] in 1902, is somewhat interesting, in view of the modern tendency to administer paraffinum liquidum in the treatment of chronic constipation.
Briquet[6] recommends 4 grammes of alum and 4 grammes of dilute sulphuric acid three times daily, with the addition of 0·05 gramme of pulv. opii at night. Briquet says that although the purgative method rapidly diminishes the colic, the elimination of the poison does not take place as rapidly as by means of the treatment he recommends, though it is open to doubt whether the use of either of these two drugs is likely to produce any further neutralization or excretion of absorbed lead than sulphate of magnesia. It is quite certain that the magnesium sulphate does not act as a neutralizer of the poison, as in a factory where sulphate of lead is manufactured some cases of definite lead poisoning occurred, in which at least half must have been due to the inhalation of lead sulphate dust. Under these circumstances it seems hardly worth while to attempt to form a sulphate of lead in the body. The action of magnesium sulphate and other salines, however, in promoting the flow of fluid towards the intestines, and rapidly diluting and washing out the contents, tend to eliminate such lead as has already been excreted into the bowel.
A number of other drugs have been given from time to time for the purpose of forming an insoluble compound with the metal in the intestine, such, for instance, as sulphur in many forms, which is still much used in French hospitals. Peyrow[7] advises sulphide of soda, whilst Meillère prefers potassium sulphide as being less irritating. He considers sulphuretted hydrogen a proper prophylactic against reabsorption. Both experimental work and clinical observation show that a change to sulphide does take place in the lower bowel, and that staining of this part of the intestine is due to lead sulphide; but as the figure on [Plate II.] shows, the lead may exist in the form of granules of a dark nature, deeply embedded in the intestinal wall, besides being situated in the exterior.
Stevens[8] suggests the use of ¹⁄₂-grain doses of calcium permanganate thrice daily to relieve pain.
A certain number of other drugs may be also made use of from the point of view of diminishing the pain, and one French observer advocates the hypodermic injection of cocaine, but it is doubtful whether any good would follow from such a procedure. Hypodermic injections of morphia should be given whenever the pain is great, and diaphoretics as well as diuretics should also be given, such, for instance, as ammonium acetate, citrate of potash, or soda. Chloroform water and chloral and bromine water may be also used, and when no other drug is at hand, the inhalation of chloroform will rapidly relieve the acute vaso-motor spasms associated with colic.
During the attack of colic, and for at least a day subsequent to its disappearance, the patient should be kept on a fluid diet; milk is best, and 10 grains of sodium citrate should be added to each glass of milk. After the colic has subsided, a light farinaceous diet should be given, and it is better not to give meat until at least a week has elapsed. Alcohol is to be avoided.