£$ rij', ■!, .( »'•':.; s#fe^i^^. -/?f .!-.;•■■ /<>'^ ;- NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service A N Inaugural Dissertation 0 N T H E COLIC, SUBMITTED TO THE EXAMINATION OB The Rev. JOHN EWING, s. s. t. p. Provost, THE TRUSTEES AND MEDICAL PROFESSORS, OF the UNIVERSITY of PENNSYLVANIA. On the twenty-second day of May, 179S, FOR THE DEGREE OF DOCTOR OF MEDICINE. By WILLIAlVrWEBB, of Virginia, Member of the Philadelphia Medical Society. To think is to theorize ; and happy the patient whose physician possesses the best theory. Darwin. PHILADELPHIA: PRINTED BY JOHN ORMROD, No. 41, Chesnut-street. 1798. * ■m DEDICATION. T O BENJAMIN RUSH, M. D. PROFESSOR of the INSTITUTES and of . CLINICAL MEDICINE, IN THE Univerfity of Pennfylvania. PERMIT ME, SIR, TO dedicate this diflertation to you, as a (lender teftimony of my refpeft; and at the fame time to return you my unfeignq^jjthanks for the ma- ny favours you have conferred upon me. The many invaluable advantages which I have received in common with others, from your public lectures ; would be alone fufficient to perpetuate a fenfe of gratitude to you ; but how vivid rauft this ever remain, whilft I continue to reflect, that to your particular attention and fuperior judgment, IV. (in my late illnefs) I am indebted for my prefent exiftence. I am now about to leave this Univerfity3 fuffer me then to bid you adieu ; may profperity and peace make your future days as happy as your paft have been ufeful j whilfl I,imprefTed with your unbounded kindnefs, will ever remain, Your mofl obedient, mo ft affectionate friend, WILLIAM WEBB. 4- INTRODUCTION. A HAVE chofen for an Inaugural Differtation that ftate of Inteftinal Difeafe known by the name of Colic: not that I expect to communicate any thing new to the public j but to avoid the difcuffion of an experimental fubject, which a late fevere in- difpofition would not fuffer me to attempt. It was my intention to have written fully on eve- ry ftage of Colic, but this I difcovered would in- volve me in a lengthy examination of every affec- tion of the bowels; not only in every ftage of Co- lic, but alfo in Dyfentery, Diarrhoea and Cholera Morbus ; as they are all the affections of the intef- tines and not characterized by any appropriate, or exclufive fet of fymptoms. I mail therefore confine myfelf to fuch affections of the inteftines, as have been defcribed by authors, under the name of Colic, Colica Pictonum, and Bilious Colic; to which I mall add fome fymptoms of Colic not hitherto ta- ken notice of. B ( 6 ) This thefts I perceive will not be exempted from inaccuracies, but this does not difcourage me; for perfection is to be found in but few Inaugural dif- fertations. The indulgent reader will make every poflible allowance, when he confiders that it is not wholly the fruits of my own experience j but con- clufions principally drawn from the opinion of other.s I write to diffufe the little knowledge I have acquired of the diforder, with an intention of do- ing good; but mould it not have the defired effect, I hope the purity of the motive will pardon the egreffion. Inaugural DifTertation. HISTORY OF COLIC. It is probable that the word colic firft took its name, from a fuppofition that the inteftine, call- ed Colon, was only affected; but now it is known that one of the inteftines can feldom be much af- fected without the whole of the alimentary canal being more or lefs difordered* : The word colic, might with propriety be blotted out of the annals of medicine; but as cuftom has eflablifhed it as a word to exprefs certain fymptoms or ftages of an inteftinal diforder, it will be perhaps proper to retain it. * This fympathy Dr. Darwin fuppofes to arifc from an aflo. ciation acquired by habit (vid. Zoonomia, part x, feet, xxxv.) Mr, Hunter fuppofes it to arife from a continuation of furfacc (vid. Hunter on the blood, See. page 7.) various other opinions have been formed by different author*, ( 8 ) The colic I fliall then define to be that ftateof the bowels, attended with a pain in the lower belly and other fymptoms, which will hereafter be defcribed. The Colic is not confined to any particular place, climate or feafon of the year, though it is moil common in warm climates, or warm feafons of cold climates. It occurs at different feafons of the year, from a change of weather ; from fuddenly refrige- rating the body after being much heated; or from fuddenly entering a warm room, drinking warm li- quors and the like, after being much expofed to the cold ; but it moft commonly occurs as the effect of marfh miafmata. Hence it moftly prevails in warm climates and in places fubject to intermitting and remitting fevers. Oe the Different Stages of Colic. The CoUc may be divided into four ftages. i. The Colic attended with partial affection or inflammation; which I mall call inflammatory Colicf. f Inflammation is not always prefent in Colic. Where the duorder is fuddenly brought on and the perfon quickly relieved ; in moft of fuch cafes no inflammation takes place ; and there are inftancei where the force of ftimulus is fo great, acting immedi- ( 9 ) 2. The Colic attended with general affection of the bowels and particularly with an inverted periftal- tic motion. This has been called the Iliac paflionf. 3. The Colic attended with a paralyfis or great torpor of the inteftines, fo that they become infen- fible to the moft powerful ftimulants; and for want of power, the vermicular motion is fufpendedj. This I (hall call the paralytic ft ate of Colic. 4. The Colic attended with the difcharge of much bile, moft commonly by vomiting, but fometimes ately upon the inteftines, as to exceed the inflammatory action. This is perhaps one reafon why inflammation has not been more frequently dtfcovered in the inteftines of perfons who die of the complaint. f The Colica Pictonum (which got its name from Riverius becaufe it particularly afflicted painttrs; and which is generally fuppofed to be produced by lead) differs not materially from Co- lics produced from other caufes; and therefore does not deferve to be diftinguifhed in a feperate clafs. X This ftage of Colic, as far as I have feen, has not been par- ticularly defcribed. Moft authors that have written on Colic, mention the uncertain operations of cathartic medicines; but few have confidered a torpid ftate of the inteftines as one of the eaufes. In this ftage it is probable the inteftines have loft their excitability from the exceffiye farce of ftimuli immediately applied to them. This I can as readily conceive as a palfy in a limb from an excefs of cxercife (vide Darwin's Zoonoraia part i. feet, xxxiv. r. 7.) an apoplexy in the brain or a proftration of ftrength in the blood-veflels, from the exceffive force of ftimulus (vide Dr# Rufh's Inquiries vol. 4, p. 155 and 170. ( «° ) by purging ; which has given it the name of bilious Colic. Of the Symptoms of Colic. i. Of the Symptoms of the Firft Stage of Colic. This is feldom attended with any other fymptom, than coftivenefs, with a pain in the lower belly. It is feldom fixed and pungent in one part, but a pain- ful diftention is in fome meafure fpread over the whole of the abdomen: and particularly with a fenfe of twifting about the umbilicus. The mufcleS of the abdomen are often confiderably contracted, and this in feperate portions, giving the appearance of a bag full of round balls*. The fibres of the colon likewife become contracted in fuch a manner that the faeces are often formed into indurated maff- es, termed by writers, fcybala; and the valve of the Colon often becomes entirely clofed, fo that none of the fasces can pafs; which readily accounts for the coftive ftate of the bowels. In fuch cafes a vomiting generally attends the complaint. 2. §f the Symptoms of the Second Stage of Colic* The pain in the lower belly and a coftive ftate of the inteftines have already been mentioned as the * Cullen. ( M ) pathognomonic figns of Colic; but when the dif- order proves more violent, other additional fymp- toms appear. The periftaltic motion is inverted, through the whole length of the alimentary canal, and in fuch a manner that the contents of the great guts, and therefore ftercoraceous matter is thrown up by vomiting, and the fame inverfion appears clear- ly from this ; that what is thrown into the rectum by glyfter is again thrown out by the mouth. This is the Iliac paflion, which differs from the firft ftage (as Dr. Cullen has juftly faid) only in degree*. Some other fymptoms than thofe defcribed are faid to occur in Colics produced by Ieac^ fuch as a conftriction of the anus, a paralyfis of the extremi- ties and affections of the nerves and brain}. 3. Of the Symptoms of the Third Stage of Colic. The fymptoms of this ftage of Colic although ap- parently milder, than thofe laft defcribed, are in ef- fect not lefs dangerous. They are, a general uneafi- nefs, attended with languor and depreffion of fpi- rits; a dull, heavy, painful fenfation over all the inteftines ; a want of appetite ; a naufea and incli- * Vide Dr. Cullen's firft lines of practice, vol. 4 page 20. % Vide Hillary on the difeafes of Barbadoes page 183. Clark, Mofely, Hunter and others have taken notice of the paralyfis of the extremities as a fymptom of Colic. ( « ) nation to vomit, and a conflant inclination to go to ftool *, though the efforts are for the moft part ineffectual: The fame coftivenefs prevails in this, as in other ftages of Colic, although the moft powerful ca- thartic medicines are retained upon the ftomach: and yet there appears to be no obftruction in the bowels which is clearly feen by the faeces, when a paffage is procured; they being thinner than natu- ral, and feldom containing any fcybala. In moft ftages of Colic the pulfe is but little alter- ed, though there is fome variation ; being fometimes full, frequent and tenfe; fometimes tenfe and fre- quent, but not full: whilft at other times it is flow, intermitting, deprefTed and fcarcely to be perceived. 4. Of the Symptoms of the Fourth Stage of Colic*, The fymptoms of this ftage or Bilious Colic are well defcribed by Sauvages, whofe defcription * Although all thefe ftages do not often terminate in one ano- ther as they are arranged, and of courfe are not apt to occur in a patient in the fame illnefs ; yet the fymptoms are fo nearly alii- ed, and fo often conneded, that they cannot otherways than be confidered as one and the fame difeafe ; and therefore with pro- priety be divided into different ftages inftead of different difeafes. ( '3 ) Wallis has imitated in his notes on Sydenham*. His words are " A hoarfenefs, cardialgia, loathing " of food, bilious, porraceous vomiting, hiccough, " the urine fmall in quantity and deep coloured, " with a coftive ftate of the bowels in general, " though not always, for fometimes they are fre- " quentfand bilious ftools ; but the pain affects the " fmall bowels, the urine flows freely ; the head is " affected with vertigo; the pulfe fmall, neither " hard nor tenfe, but frequent, and is often fuc- " *ceeded by jaundice." Of the Caufe and Connection which exifl between the different Stages of Colic. The alimentary canal, like other parts of the bo- dy is liable to be affected in different ways according to the different degrees of excitability and the force of ftimuli applied. Thus if a perfon habituated to Colicf, be expofed to much cold, his digeftion will be impeded and the excitability of the inteftines will be accumulated; in this ftate of the fyftem, the heat of a room, which at another time would produce * Vid. Wallis' Sydenham, vol. i. page 276. f If the inteftines have not beea fubject to Colic or other af- fedions, the increafed excitement is as apt to terminate upon the pleura, or any other part as upon inteftines. C ( 14 ) no bad effeft,will now produce inflammation*, and its confequences, fuch as pain, coftivenefs and the like. If in the above ftate of the fyftem, the room be ftill warmer, a greater degree of excitement will be produced; the whole of the inteftines will be affect- ed, and an inverted periftaltic motion will be the effectf. If the flimulus be ftill greater ; the aftion of the inteftines becomes proftrated and the faeces are re- tained from a ceffation of the periftaltic motion}; which is found neceffary to protrude them. The inteftines in this ftage become fo infenfible to the action of other ftimulants, that the moft pow- erful cathartic medicines have not the defired ef- fect §. (Page 9 & 12.) It may be produced by any vi- * Darwin. •j- In this cafe a quantity of water is thrown up by vomiting, although the patient drinks but little. Dr. Darwin thinks it pof- fible that this fuperabundance of water may be abforbed from the atmofphere by the increafed action of the cutaneous abforbents, and then retrograded by the inverted motion of the intefti nal ab- forbents (vid. Zoonomia, part i, feet. xxxv. 15.) J If the retention of the fasces depend not upon obftruction, it muft be owing to a want of vermicular motion (vid. page 9.) § An ingenious friend ef mine informed me that he gave a pa- tient (whofe bowels were in this torpid ftate) 52 grains of emetic ( 15 ) olent ftimulus, acting upon the increafed excitabi- lity ; but marfh miafmata may be confidered as the moft common remote caufe. Hence it feldom ap- pears, but in the fall feafon, and in fituations fubject to intermitting and remitting fevers, If, in the above ftate of the fyftem, the patient happens to be of a bilious habit, and particularly, if he happens to be in a place fubject to bilious fe- ver, a greater degree of excitement will be produc- ed ; but, in moft cafes, affedts principally, the blood-veffels, and produce a bilious fever, which after no great length of time, will terminate in a bilious colic. Dr. Sydenham fays, that the Bilious Colic often fucceeds inveterate dyfenteries, and when it did not, it generally arofe from a fever which affected tartar and 85 of ipecacuanha, within the courfe of thirty-fix hours, without producing a fingle evacuation, cither by vomit or ftool: and I once exhibited 50 grains of calomel and as many of jalap, in the courfe of tweHtyfour hours, with no better fuccefs ; which after two or three bleedings, a paffage by ftool, was procured by only 36 grains of jalap. The fasces when dif- charged were thinner than natural, and had no fcybala among them. The inteftines muft certainly have been in this paralytic ftate, when Dr. Chifholm gave a patient 50 grains of calomel at a fin- gle dofc. ( '6 ) the patient only a few hours, and ordinarily termi- nated in this difeafe* : but according to my own ex- perience, I cannot fay this was altogether the cafe. The diforder generally commenced with a fever, which after no determinate length of time abated, and the fymptoms of colic appeared, fo that it feemed as if the excitement was tranflated from the blood-veffels to the inteftines; but the convulfive action of the pulfe and fome other fymptoms of fe- ver generally appeared. I once faw a patient with this colic, who had been previoufly affected for three days with a bilious fever : the violence of the fever fuddenly fubfided, and he was attacked with pains in his bowels, a perpetual vomiting of bilious matter; and coldnefs on the furface of his body and in his extremities, his neck and breaft were the only parts that could be perceived to be warm, yet he complained of the moft violent heat within ; but the mod diflreffing fymptom was the difficulty of his breathing; for which he was bled once or twice and was relieved. The irregular tremulous action of his pulfe, and the internal heat, indicated the prefence of fever in this cafe ; as it does in moft other cafes of bilious colic. * Vide Wallis' Sydenham, vol. i, page 174. ( 17 ) There is but one remote caufe of fever*; and there is but one remote caufe of colic, and that is ftimulus. Heat alternating with cold, marfh miaf- mata ; the fumes of lead and other poifons; paf- fions of the mind, and the like, all act by a ftimu- lating power producing colic. Hence it is that the fymptoms of the colic are the fame, differing only in degree, although the caufes which produce them are innumerable. The paralyfis of the extremities, in colic, has moflly been afcribed to the effects of lead ; but this effect can only be produced from the exceffive force of ftimulus, or the length of time for which it is applied ; this appears clearly from its being produc- ed from other caufes than that of leadf ; and often from fome of the other caufes which produce colic, as marfh miafmata}, viciflitudes of the weather and the like : and if the opinion of Dr. Clarke be well * Vide Dr. Rufh's Inquiries, vol. 4, page 132. f A large dofe of opium, night (hade, or any other powerful ftimulant, will produce a paralyfis in the extremities by being ta- ken into the ftomach. Hence poifons generally produce apo- plexy, when they deftroy life. X Mofely in his treatife on topical difeafes, fays that the colica nidtonum was epidemical in certain fituations at certain feafons of the year ; from this I would rather fuppofe it was produced from marfh miafmata than lead; for the effects of lead are the fame at all feafons of the year. C i» ) founded, other colics in warm climates than thofe produced from lead, are attended with paralyfis of the extremities*. He fays, that the colic, which moft frequently occurred during his two voyages to India, either refembled the bilious colic of Syden- ham, or the colica pictonum, dry belly-ach and nervous colic of other authors. He fays that the paralyfis of the extremities was a common fymptom. of thofe colics; and he confidered the remote caufe to be the fudden refrigeration of the body whilfl over-heated. Of the Cure of Colic. The remedies which have been recommended in, the cure of Colic, are very numerous; but in the prefent improved ftate of medicine, I conceive they may be reduced to a very few, fuch as, i. Blood-letting. This remedy has been con- fidered by fome as valuable, whilfl others have ta- ken no notice of it, in the cure of Colic. Dr. Culr len recommends bleeding in the firft ftage j-; Wallis in the fecondj ; Sydenham in the fourth § ; and the * Vide Clark on the difeafes of long voyages, p. 396. t Vide Cullen's firft lines of praftice, vol. 4, p. 20. X Vide Wallis' Syde nham, vol. 2, page 69. §-------------- page 277. ( «9 ) advantage I have derived from it warrants me in re- commending it in the third ftage of Colic: but as fome regard fhould be paid to the quantity of blood to be drawn in the different ftages there may be fome advantage derived from a difcrimination. i. Stage. As the inteftines are not alway inflam- ed fo blood-letting is not alway neceffary ; but in paroxyfms of Colic, inftantaneous relief has been procured by bleeding, even where no inflammation had taken place ; where large dofes of laudanum had proved ineffectual. Blood-letting diminifhes the irritation and pain of the inteftines, and thereby prevents thofe conftric- tions, which are fo often the caufe of coftivenefs ; and if timely ufed, prevents that inverted motion of the inteftines, which I have called the fecond ftage. The quantity of blood to be drawn fhould de- pend upon the violence of the fymptoms. In moft cafes, in the inflammatory ftage, from 10 to 20 ounces may be taken at a time, which fhould be repeated as often as the fymptoms require it. It never fails to affift the operation of cathartics, and eafe the pain in the bowels if fufficiently ufed. 2. In the Iliac paflion blood-letting acts as an ano- dyne ; and the effects are not fo different from the ( *0 ) effects of opium as has been imagined : blood-letting by abstracting the ftimulus of blood from the intef- tines diminifhes the excitement. Opium, by increaf- ing the force of ftimuli overcomes the excitement, and the fame effects are produced. In both cafes the excitement and the excitability are equalized*. The preference to blood-letting in this cafe is evi- dent ; for by bleeding we only leffen the bulk of blood, which is too great a ftimulus for the veffels which carry it. By opium we endanger the life of the part; for it is from the exceflive force of flimu- li, that inflammation terminates in mortification!. In a cafe of this ftage of colic, where the periftal- tic motion of the inteftines was inverted, which was evinced from the ftercoraceous vomiting ; and, at the fame time the ftomach was fo irritable, that nothing could be made to remain upon it. The pa- tient was relieved in two days by three bleedings. Small quantities of blood taken at a time, and frequently repeated, will in general be found moft advifeable in this ftage of colic ; but as the fymp- toms often differ, the rule laid down by Dr. Rufh, fhould always be remembered. " In cafes" fays the Doctor, " where the pulfe acts with force and * Vide Dr. Rufh's manufcript lectures. f Vide Bell, Cullen, Hunter and Darwin. ( 21 ) !< freedom, from io to 20 ounces of blood maybe " taken at once ; but in cafes of great indirect de- " bility, where the pulfe is depreffed*, it will be bet- " ter to take away but a few ounces at the time, and " to repeat it three or four times a dayf." 3. In cafes of the paralytic ftate of colic, the action of the inteftines is fuppofed to be overcome by the exceflive force of ftimuli. In this cafe, by fmall bleedings the quantity of blood fent to the inteftines is gradually diminifhed, and the force of ftimuli being leffened, the action of the inteftines is again reftored. Six or eight ounces of blood may be taken at once, and this fhould be repeated three or four times a day, according to the effects that are prod'iced{. It proves more beneficial than the fame quanta :y of blood taken at larger bleedings. The feeming debility of the patients in this ftage o;" colic, often makes fuperficial obfervers object to tie ufe of the lancet: I ffcall ever lament the death * In a flow intermitting pulfe, or a frequent tenfe pulfe, where it is not full, fmall and repeated bleedings fhould be preferred, to a fiu ;le bleeding which is large. -J- Vide Dr. Rufh's Inquiries, vol, 4. page 239. X Where the pulfe is preternaturally flow, and becomes quicker and more regular, or where the pulfe is quicker than natural, and becomes flower and fuller by bleeding, we may be confident the effects are falutary. D C 22 ) of a young man, who was affected with this colic, and whofe friends perfuaded him againft the ufe of the lancet; from their fuppofing he was too weak to bear the lofs of more blood. Eighteen ounces had been taken at three bleedings, with the appear- ance of advantage ; but he died, for the want of more bleeding! altho' many other meafures were taken for his recovery. In this cafe fome ftools were procured by ftrong cathartic medicines, which fhewed no figns of fcybala. 4. In no diforder is blood-letting more efficacious than in the bilious colic. Many lives have been fav- ed by this remedy; which would inevitably be loft without it: witnefs the cafe (in page 16.) His dif- ficult breathing was removed; his vomiting flop- ped, and the heat was reftored to every part of his body. In the bilious ftage of colic, large bleedings will moftly be required; but the fymptoms fhould indi- cate the quantity to be taken*. 2. PURGING. This remedy has moftly been depended upon in the cure of colic ; but much mifchief has been * Vid. page 20 & 21. ( n ) done by the untimely ufe of this clafs of medicines. The irritation that muft be produced by the fti- mulant properties of the medicine, acting upon a part already highly excited, muft deter any practi- tioner from the ufe of cathartics at fuch a time, did not a fuppofition arife, that a paffage muft be pro- cured, and that could only be done by the ufe of fuch medicine*. Belldes, by the dependence on purgatives, the difeafe has been prolonged for 20 or 30 days, whereas, had the excitement been leffen- ed by the previous ufe of the lancet, the cure might have been performed in half of the time. The uncertain fuccefs in the cure of colic by the ufe of purgatives, is no doubt the caufe of the dif- ferent opinions, as to the time to exhibit them, and quality of purges that fhould be ufedf. Sydenham was certainly well acquainted with' the cure of the difeafe, when he " bled freely" before he exhibited any medicine J. The moft judicious method of curing the colic, is firft to diminifh the excitement by blood-letting ; * In an obftruction of my bowels which had continued for three days, a paflage was procured by the lofs of 12 ounces of blood, which 1 took to cafe the head-ach. I had taken no kind of medicine, neither had I made any material change in my diet. f Vide Hillary, Clark, Mofeley, Hunter and others. X Vide Wallis' Sydenham, vol, 2, page 277. ( 24 ) and afterwards the bowels may be more eafily open- ed by purges. The kind of purges to be preferred muft depend upon the excited ftate of the fyftem; when this is equalized with the excitability, the mildeft laxatives will anfwer the purpofe. Thus opium, which is of an ailringent quality, has been laid to aflift the operation of cathartics in colic*. When the bowels are once opened, they fhould be preferved in this fituation, either by a proper ac- commodation of diet, by the farther ufe of laxa- tives, or by glyfters. 3. GLYSTERS. Glyfters have been highly recommended in this difeafe, and when purges are rejected or become in- expedient, they may be ufed with advantage. Cold water glyfters have of late been highly recommend- ed in the colic. Dr. Cullen recommends the injection of tobacco fmoke, and mechanical dilatation in the cure of co* lief ; but if the lancet be ufed with fufficient free- dom, I doubt if thefe harfh remedies would ever be found neceffary. The moft violent fpafm I ever * Vid. page 20. f Vid, Cullen's firft lines of practice, vol. 4, p. 31, 32 & 35. ( *5 ) few was overcome by three bleedings ; when cathar- tics, glyfters, and injections of tobacco fmoke had all failed. 4. STIMULANTS OR .EXCITANTS. 1. Mercury. This has been of late highly re- commended in the cure of colic. In violent cafes of colic, Dr. Clark made three pills, from a mafs of 10 grains of calomel and 2 of opium; one of which he gave every half hour till the pain abated ; after which he exhibited a purge*. The fame au- thor takes notice of a violent cafe of colic, produc- ed by lead, which was cured by a falivation*. 2. Hyofciamus and opium have both been high- ly recommended in the cure of colic. They act either by overcoming the excitement, by increafing the force of ftimuli, or, by increafing the excite- ment when below par, to the ftate of equilibrium!. The firft intention is to be anfwered by a large dofe of the medicine, which fhould not be repeated; the fecond by giving fmall dofes, and repeating them as foon as the effect of the medicine is per- • ceived to decline J. In ufing thefe medicines, the * Vide Clark on the difeafes of long voyages, page 398. f Vide Dr. Rufh's manufcript lectures. | Vide Darwin's Zoonomia, part 1, feet, xii. 7. C 26 ) laft intention will be found more advifable than the firft ; for by the means of the lancet the firit is ef- fected with more fafety and certainty. 3. Other medicines than thofe mentioned, have been prefcribed by authors for the cure of colic; fuch as the fulphate of zinc, acetate of lead, gum guaiacum, &c. for the good effects of which, Mofeley, Hillary, Hunter, Linn, Clark, and others who have written on the diforder may be confulted. 5. BLISTERS. Thefe have been recommended by Cullen, Clark and others. They may be ufed with advantage in fome ftages of colic. They act by creating an ex- citement on the furface of the body, and thereby diminifhing the excitement in the inteftines. In the convalefcent ftate of colic, exercife on horfeback ; the peruvian bark, and other tonics, will be found equally neceffary, as in convalefcents from fever. In cafes of the chronic ftate of colic, appearing in irregular paroxyfms, brought on by a fedentary life ; by bad air ; from lead or other poifons. Exer- ( *7 ) cife on horfeback; country air ; an accommodation of cloathing to the weather; the avoiding of night air, and all exceffes; together with the occafional- ly letting a little blood, as the pulfe may indicate, will generally perfect a cure. WZ 1.10 1198 '""■tv*-'^-'