Colic

lead disease pain spasmodic patient

COLIC (from I: (11 X o v , the large intestine). By this term is generally understood an attack of pain in the abdomen, usually seated in the neighbourhood. of the navel,of spasmodic character, and attended for the most part with constipation of the bowels. Various forms of this complaint are described by medical writers. The most important are simple or flatulent colic and lead colic. The former of these commonly arises from the presence in the alimentary canal of some indigestible matter, which not only excites spasmodic contraction of the muscular coats of the intestines, but also, by beginning to undergo decomposition, gives rise to the presence of gases, which painfully distend the bowels and increase the patient's suffering. The pain of colic is relieved by pressure over the abdomen, and there is no attendant fever - points which are of importance in distinguishing it from inflammation.

Attacks of this form of colic may occur in connection with a variety of causes other than that above mentioned, e.g., from accumulations of feculent matter in the intestines in the case of those who suffer from habitual constipation ; also as an accompaniment of nervous and hysterical ailments, and not unfrequently as the result of exposure to cold and damp, particularly where the feet become chilled as in walking through snow. Similar attacks of colic are apt to occur in young infants, especially those who are fed artificially; and in such cases it will generally be found that the food is passing through them almost wholly undigested, and that a temporary change of diet will be necessary. The duration of an attack of simple colic is seldom long, and in general no ill consequences follow from it. It is, however, not free from risk, especially that of sudden obstruction of the bowel from twisting, or invagination of one part within another (in tussusception) during the spasmodic seizure, giving rise to the terrible disease known as ilcus.

Of greater importance and interest in a medical point of view is the disease known as lead colic (Syn. painters' colic, colica Pictonum, Devonshire colic, dry belly-ache), from its having been clearly ascertained to be due to the absorption of lead into the system. This disease had been observed and described long before its cause was discovered. Its occurrence iu an epidemic form among the inhabitants of Poitou was recorded by Francis Citois, in 1617, under the title of Konts et popularis apud Pictones dolor colicus liiliosus. The disease was thereafter termed colica Pictonnm. 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 he caused by the admixture of acid wines with litharge to sweeten them.

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

It has subsequently been made out that this complaint is apt to affect all persons who work among lead or its preparations, especially lead-miners, manufacturers of white lead, colour-grinders, and painters, also to a less extent plumbers, potters, type-founders, It is said to have occurred in persons who have slept for only a few nights in a newly-painted room. It has frequently arisen from the use of drinking water containing salts of lead in solution, as also from food and condiments adulterated with preparations of this metal, and it has even been known to follow the habitual use cf cosmetics composed in part of white lead.

The colic due to lead poisoning, which in its general characteristics is essentially the same as ordinary colic, is only one of a train of symptoms produced by the absorption of lead into the body. From prolonged exposure to the action of this poison, the general nutrition of the body becomes deteriorated, and serious nervous phenomena present themselves, sometimes in the form of epilepsy and coma, but more usually as a variety of palsy. This palsy is of local character, affecting in the first instance the muscles composing the ball of the thumb, and also those muscles of the fore-arm which extend the wrist, and giving rise to the condition known as " wrist-drop," from the circumstance that when the arm is extended the hand hangs down and cannot be raised by voluntary effort. The affected muscles undergo atrophy while the paralysis continues. If the patient is removed from further exposure to the influence of the lead poison, and suitable treatment employed, complete recovery from all the ill effects may take place ; but otherwise all the symptoms become aggravated, the health becomes completely ruined, and death may result.

One of the phenomena which accompany lead poisoning is the existence of a blue line along the margins of the gums where they meet the teeth. This is ahnost never absent, and is an important aid to the diagnosis of the disease.

The absorption of copper into the system produces a series of symptoms similar to those of lead poisoning, including a form of colic. It is of comparatively rare occur rence, being chiefly observed among workers in copper.

The treatment of colic consists in means to relieve the spasmodic pain, and in the removal, where possible, of the cause upon which it depends. The former of these indica• tions is fulfilled by the administration of opiates (except in the case of children) and the application of warm fomentations to the abdomen. Where the attack appears to depend on accumulations of irritating matter in the alimentary canal, a brisk purgative will, in addition, be called for.

In the case of lead colic it is imperatively necessary that the patient be removed from the source of the lead poisoning. Here, too, the free evacuation of the bowels by castor oil or saline purgatives is an important part of the treatment. As an antidote to the lead absorbed into the system, the administration of iodide of potassium is recommended, while for the paralysis nerve tonics, such as quinine and strychnia, and the use of galvanism, will in general yield good results. Where the patient's occupation necessitates his exposure to the constant influence of the lead poison, as in the case of colour-grinders or manufacturers of white lead, the evil consequences can in great measure be averted by scrupulous attention to cleansing the body, particularly before eating, by abstention from eating in the work places, and by the habitual use of a drink slightly acidulated with sulphuric acid.

The terms hepatic colic and renal colic are applied to that violent pain which is produced, in the one case, where a biliary calculus or gall stone passes dawn from the gall bladder into the intestine, and in the other where a renal calculus descends from the kidney along the ureter into the bladder. These affections are, however, entirely different from true colic. (J. O. A.)

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