Change of position produces a succussion sound, and dilatation of the sigmoid flex ure may be ascertained, which may be beyond the median line. In the same manner displacement of the transverse colon may be determined, and if simple atony only is present the spashing will be heard in the normal position of the colon, while if there is also displacement the sound will be heard under the um bilicus. It is indispensable to evacuate the intestine with a purgative before performing this lavage. In catarrh of the intestine the water will return charged with mucus and false membrane, while if the intestine is normal the water will be clear or will contain only some slight epithelial (16bris. Boas (Deutsche med. Zeit., Jan. 15, '95).
TWO cases of "aneurismal" dilatation of the colon as the result of chronic con stipation. In both cases the site of the tumor was the same: in the last portion of the sigmoid flexure. The impaction of fmcal masses in this region tends to produce dilatation behind it, and this distension may be localized or general. General dilatations are relatively com mon. While the condition of the first case could only be accurately diagnosed at the time of the operation, the great mobility of the tumor which subse quently developed itself in the second case gave rise to the belief that in this instance also would a "pedunculated" tumor be met with, for on various occa sions it could be demonstrated bimanu ally that the lesser cavity of the pelvis was absolutely free, the tumor itself being felt well above the pelvis. S. L. Wooliner (Lancet, June 16, 1900).
Afore or less distension of the colon is a common symptom resulting from ac cumulation of gases in nearly all the cases of ordinary constipation.
Atony of the intestine should be sepa rated from chronic constipation, which is often only a symptom of the former con dition. The atony -usually affects the colon, which is unable to expel the faeces. It may be primary, as the result of im proper diet, sedentary habits, or a, too frequent use of cathartics; or it may be secondary to many disorders, as obesity, disease of the heart, lungs, or liver, ty phoid fever and other intestinal disease's, or organic nervous diseases. It is often found in childhood and may be con genital. The symptoms are marked con stipation, headache, vertigo, nausea, and pains in the back and loins. Nervous :symptoms are often present. The signs are marked tympany and sometimes the ability- to detect the distended colon and feecal masses by palpation. Frieden
wald (Med..News, Aug. 11, '94).
But dilatation as a primary patholog ical condition causing constipation, with out having been preceded by either in testinal paralysis or some form of ob struction, is certainly of rare occurrence; as recently shown by Mr. Frederick Treves, who suggests "that the cases of idiopathic dilatation of the colon in young children are due to congenital de fects in the terminal part of the bowel," and consequent obstruction.
Pathology.—The various pathological conditions accompanying constipation have been sufficiently stated in connec tion with its etiology and diagnosis. Con stipation, when permitted to continue several days, may give rise to irritation or inflammation of the mucous mem brane in contact with the retained fmces, causing temporary diarrhcea with pain or tenesmus.
In all cases of chronic constipation there is a considerable degree of chronic irritation and subacute inflammation of the crecum and colon and of the sur rounding cellular tissues; this condition not infrequently becomes acute, and is then recognized as an attack of typhlitis. The effect of this subacute inflammation is reflexly to arrest peristalsis. When a puigative is administered in such cases, peristaltic movements are induced, the irritation is increased, and after the evacuation of the bowels, which is rarely complete, tbe gut becomes more torpid than before. Nevins (Brit. Med. Jour., Dec. 27, '90).
One of the many functions of the ilea erecal opening is to prevent the too rapid emptying of the small bowel, and to maintain some pressure against peri stalsis until the process of sniall bowel digestion is properly, finished. Mayo (Boston Med. and Surg. Jour., May 16, 1901).
But the more frequent result is the formation of septic materials and their absorption, constituting a degree of auto infection by which the general feelings of depression, loss of appetite, vertigo, and paroxysms of sick headache are pro duced.
Emphasis upon the indolence of the cwcum occurring in children of sufficient age to be left considerably to themselves. They eat in a careless manner, and fre quently eat too much. The food remains in the ccum and large intestine, giv ing rise to such symptoms as headache, incapacity for study, paleness, and ir regular and capricious appetite. Jules Simon (Revue Gen. de Clin. et de Then Jour. des Practiciens, June, '95).