Colic

Colic (from the Gr. κόλον or κῶλον, the large intestine), a term in medicine of very indefinite meaning, used by physicians outside England for any paroxysmal abdominal pain, but generally limited in England to a sudden sharp pain having its origin in the pelvis of the kidney, the ureter, gall-bladder, bile-ducts or intestine. Thus it is customary to speak of renal, biliary or intestinal colic. There is a growing tendency, however, among professional men of to-day, to restrict the use of the word to a pain produced by the contraction of the muscular walls of any of the hollow viscera of which the aperture has become more or less occluded, temporarily or otherwise. For renal and biliary colic, see the articles Kidney Diseases and Liver, only intestinal colic being treated in this place.

In infants, usually those who are “bottle-fed,” colic is exceedingly common, and is shown by the drawing up of their legs, their restlessness and their continuous cries.

Among adults one of the most serious causes is that due to lead-poisoning and known as lead colic (Syn. painters’ colic, colica Pictonum, Devonshire colic), from its having been clearly ascertained to be due to the absorption of lead into the system (see Lead-Poisoning). This disease had been observed and described long before its cause was discovered. Its occurrence in an epidemic form among the inhabitants of Poitou was recorded by François Citois (1572-1652) in 1617, under the title of Novus et popularis apud Pictones dolor colicus biliosus. The disease was thereafter termed colica Pictonum. It was supposed to be due to the acidity of the native wines, but it was afterwards found to depend on lead contained in them. A similar epidemic broke out in certain parts of Germany in the end of the 17th century, and was at the time believed by various physicians to be caused by the admixture of acid wines with litharge to sweeten them.

About the middle of the 18th century this disease, which had long been known to prevail in Devonshire, was carefully investigated by Sir George Baker (1722-1809), who succeeded in tracing it unmistakably to the contamination of the native beverage, cider, with lead, either accidentally from the leadwork of the vats and other apparatus for preparing the liquor, or from its being sweetened with litharge.

In Germany a similar colic resulting from the absorption of copper occurs, but it is almost unknown in England.

The simplest form of colic is that arising from habitual constipation, the muscular wall of the intestines contracting painfully to overcome the resistance of hardened scybalous masses of faeces, which cause more or less obstruction to the onward passage of the intestinal contents. Another equally common cause is that due to irritating or indigestible food such as apples, pears or nuts, heavy pastry, meat pies and puddings, &c. It may then be associated with either constipation or diarrhoea, though the latter is the more common. It may result from any form of enteritis as simple, mucous and ulcerative colitis, or an intestinal malignant growth. The presence of ascaris lumbricoides may, by reflex action, set up a very painful nervous spasm; and certain forms of influenza (q.v.) are ushered in by colic of a very pronounced type. Many physicians describe a rheumatic colic due to cold and damp, and among women disease of the pelvic organs may give rise to an exactly similar pain. There are also those forms of colic which must be classed as functional or neuralgic, though this view of the case must never be accepted until every other possible cause is found to be untenable. From this short account of a few of the commoner causes of the trouble, it will be clear that colic is merely a symptom of disease, not a disease in itself, and that no diagnosis has been made until the cause of the pain has been determined.

Intestinal colic is paroxysmal, usually both beginning and ending suddenly. The pain is generally referred to the neighbourhood of the umbilicus, and may radiate all over the abdomen. It varies in intensity from a slight momentary discomfort to a pain so severe as to cause the patient to shriek or even to break out into a cold clammy sweat. It is usually relieved by pressure, and this point is one which aids in the differential diagnosis between a simple colic and peritonitis, the pain of the latter being increased by pressure. But should the colic be due to a malignant growth, or should the intestines be distended with gas, pressure will probably increase the pain. The temperature is usually subnormal, but may be slightly raised, and the pulse is in proportion.

In the treatment of simple colic the patient must be confined to bed, hot fomentations applied to the abdomen and a purge administered, a few drops of laudanum being added when the pain is exceptionally severe. But the whole difficulty lies in making the differential diagnosis. Acute intestinal obstruction (ileus) begins just as an attack of simple colic, but the rapid increase of illness, frequent vomiting, anxious countenance, and still more the condition of the pulse, warn a trained observer of the far more serious state. Appendicitis and peritonitis, as also the gastric crises of locomotor ataxy, must all be excluded.

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