Symptoms Of Colic Research Articles

A widow lady, aged 53, inclined to corpulency and of somewhat gouty habit, had been for many years the subject of intermittent attacks of acute epigastric pain, accompanied by vomiting, and lasting, as a rnle, for two or three days. The first attack had occurred some twenty-three years previously, and had persisted for several weeks. It was of a far severer type than those whicn succeeded it, and Was characterized by jaundice and the usual symptoms of biliary colic. Although no calculus was dis covered in the ?jecta, the symptoms pointed so clearly to the presence of a gall stone, that, both this attack and those which succeeded it were regarded as similar and due to this cause. With the exception of an attack of fever, which was supposed to have been malarial in nature, and which occurred a few years previously, while the patient was living in the neighbourhood of Delagoa Bay, there was no history of illness. In June, 3899, the patient noticed that her water became high coloured and the motions pale. On July sst she began to feel definitely ill, and experienced considerable pain in the epigastric region, slightly to the right of the middle line. The temperature rose to 305o F. ; she became very restless and slightly delirious, but on the following morning was sufficiently well to get up and dress. That evening, however, she slipped as she was walking downstairs, and was very seriously shaken by the fall. On the following day (July 2nd) a doctor was called in, and her temperature was found to be 301o F. She was ordered to remain in bed, and during the following days the fever was remittent. With each rise she became somewhat collapsed and restless, but during the remis sions she felt perfectly well. Jaundice, however, soon developed, the stools became clay-coloured and the urine deeply pigmented. On July 36th she was removed from the country, where the illness had com menced, to London. On July 24th I saw her for the first time. On that day there had been a considerable exacerbation of the symptoms. The temperature had gone up to 305o. and she was in great pain in the area previously described. The pain was of a sharp, shooting character, and went right through to the back. There was, however, no discoverable tenderness on percussion or palpation. The tongue was very dry, and thickly coated. The skin was deeply jaundiced, but not noticeably dry, and the conjunctivae were distinctly yellow. The area of liver dullness was small and not easily defined, owing to the tympanitic distension of the colon. The pulse was 98, there was a slight systolic apical bruit, and the urine, specific gravity of 3020, contained bile pigments and bile salts, but no albumen, and the reaction was acid. The motions were colourless, greasy, and very offensive. The patient was ordered to be sponged with iced water, to drink plenty of lemon juice and Vichy water, and to take 30 gr. of trional at night. The next morning?July 2sth?the pain had disappeared, and the face had lost its drawn and anxious expression. The urine was lighter in colour, and the motions, though still light, could hardly be described as clay-coloured. Each motion was carefully strained through gauze, and examined for gall stones, but none were found. The temperature had meanwhile fallen to 300o, and although weak and exhausted there were no symptoms to cause anxiety. On July 28th a consultation was arranged with Sir William Broadbent and Dr. Arthur Lambert, of Harrow, a member of the patient's family. The question of gall stones with or without the complication of malig nancy was fully considered, and an expectant treatment advised. The temperature, however, still continued to be extremely irregular. There were occasional rigors with exacerbations of pain, which usually termi nated in free perspiration and great exhaustion. The skin still had a deep ictef ic tinge. Since the symptoms showed no tendency to improve and the patient was becoming decidedly weaker, it was considered advisable to consult Mr. Herbert Page with regard to the surgical aspects of the case. Mr. Page's examination, however, failed to discover any definite cause for the symptoms. Ho did not think there was any deep-seated focus of sup puration, neither did he think it was probable that malignancy or malaria complicated the case. The temperature, he thought, might be due to reflex irritation.

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