Paroxysms of Iliac Pain relieved by Coffee

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Article XXII.—Paroxysms of Iliac Pain relieved by Coffee. By Dr. Lazarus.

An usual form of what would be generally termed colic has presented to me several instructive phenomena. It has occurred during the last four or five years, at first at rare intervals, and under the form of a hernia of the left inguinal canal, never coming down into the scrotum. This was not always accompanied with pain or signs of visceral disturbance, and yielded to a careful exercise of the taxis, so that I came to regard the difficulty as one of rather a mechanical character, and the pain as the ordinary effect of strangulation. I observed that a cup of good coffee acted like a charm in facilitating the reduction of the hernia, and in re-establishing the normal peristaltic movement.

Within the last eighteen months I have suffered, on an average, as often as every six weeks, paroxysms of this peculiar strangulating pain, sometimes connected with palpable hard distensions of the bowel, as large a£ my fist, above the left inguinal canal; sometimes equally severe, with no hernia nor palpable distension any where. When any circumstance has prevented me from getting, at the very beginning, a cup of strong Mocha or Java coffee, well made, and not spoiled by boiling it; the disease has become dangerous and obstinate, presenting the following characters : pain of a pinching or strangulative character, circumscribed, lying in a tract from the left inguinal to the umbilical region, always to the left side of the median line, sometimes so violent as to compel me to roll on the floor, seeming to demand pressure and friction, which however gave no relief.

The paroxysm, when not interfered with by remedial measures, never passes off, but increases in violence and obstinacy, its longest duration was three days and two nights, it then came near killing me, and was eventually relieved by repeated and copious injections of soap-suds as warm as could be borne.

There is not usually constipation; when there is, the rectum and colon are easily moved and discharged; this doubtless facilitates the ultimate relief, but by no means suffices to procure it; the most obstinate and protracted pains having persisted unchanged after such evacuations, and sometimes been suddenly relieved without evacuations of the lower bowels or even any sensible passage of wind. On one of the more recent occasions a sitz-bath of cold spring-water, twelve inches deep, continued about fifteen minutes, procured such a spontaneous cure after twelve hours of suffering, and when hot fomentations and hot injections frequently repeated, had failed. The attacks generally came on early in the morning, and suddenly, without previous indisposition, sometimes after having slept comfortably. (My sleep is habitually too short and too light.) I have several times thought the attack due to having eaten acid fruits, especially baked apples, the day before. At other times, I could accuse myself of no indiscretion in diet. Whether occurring early in the morning or at other hours, the paroxysms have always observed a sufficient interval after meals to allow the presumption that the small intestines were partially empty, and they have never occurred at night after I had retired to bed.

If relief is not promptly obtained, the stomach sympathizes within an hour, then vomitings commence and the coffee becomes useless, because it is not retained or not absorbed ; the vomitings become more violent as the paroxysms are prolonged, they give indirectly a partial relief, after having thrown the body into general perspiration in the muscular effort, but this is very transient. The secretions of the stomach are quite normal. After some hours, hiccough sets in, and continues, very annoying, until the whole paroxysm is relieved. The seat of the pain being too low to be affected by the most violent vomiting, and too high to be reached when the colon is filled with injection, must be referred to the small intestines, and from its location on the left side, with a tendency to the inguinal ring, I have referred it to the ilium, which is frequently concerned in such hernias.

Warm fomentations and dry heat applied over the seat of the pain always exercise a palliative influence, and in some slight attacks proved very useful, but they are inadequate and unreliable, whether water or spirits be used.

The same remark applies to the hot sitz-hath and the vaporbath and to mustard-plasters. Injections of coffee deserve attention; I have tried them with success after some hours of suffering. I have tried ineffectually on several occasions, Nuxvomica, Bryonia and Colocynth in low dilutions. The effect of coffee is clearly specific ; and it fulfils every indication of cure very promptly when the conditions of its absorption exist. It is probably in the volatile oil that this virtue resides, as I have found no effect from boiled coffee that had not the aromatic flavor. I commend the experimental employment of coffee, prepared either according to the French or Turkish formula, not only for nervous and spasmodic colics, but also as a resource which may aid the taxis in strangulated hernias, by energizing the peristaltic movement of the intestine. The oil of coffee might be rubbed into the skin, or absorbed from injections when the stomach will retain nothing.

M. E. Lazarus.

[North American journal of homoeopathy, Volume 6, p. 224.]