These symptoms may be accompanied ty other insignificant general ones— } erhap.s a slight headache and a feeling ef distension; but, when the obstruction 1_ ecomes marked, then those recalling acute obstruction appear: abdominal pain, vomiting, abdominal distension, borborygmus, etc. The peristaltic action 4 the intestine may be easily discerned, ma only by the hand, but visually. Pal i ation sometimes makes it possible to dis tinctly locate the impacted mass through the abdominal walls.
These attacks may recede—generally throug.h successful efforts to move the intestines by injections, salines, etc., to which the patient has become habituated, Lut they finally become frequent, the t;ent gradually becoming emaciated and anTmic until unconquerable occlusion ;;,--iirs, when the ease becomes, in point f severity, one of acute obstruction, with all As.. attending dano-ers—increased to a marked degree by the gradual decline of the vital resistance of the organ involved. In chrnnic obstruction due to other eicatricial -he symptoms do not vary much from tb-se just enumerated, but in cases of cancerous stricture the facies may afford an early clue to the nature of the causa tive disease present.
seat of the impaction 'mist first be detected—a feature present ing no little difficulty, unless, as is some times the case in chronic obstruction, the mass be distinctly- felt through the ab dominal walls. Even when this valuable sign cannot be obtained, however, in spection of the abdomen affords inueh information. By carefully palpating its entire surface areas of comparative re sistance may be detected, or the outline of a section of intestine, the curve of tbe colon, for instance, can be clearly made out, sometimes as a rigid tube of large size. This may be due to spasm or to the accumulation of gases, the latter tending to indicate, when the gut is tense, that the obstruction is low down. If the ob struction is in tbe ascending colon or the first half of its transverse portion, it may often be made out by following the course of the gut from the clecum. Pain is usually sharpest at the seat of occlusion.
When the occlusion appears to be situ ated (judging from the inflated colon) in the posterior part of the transverse por tion or lower, a systematic examination should be resorted to, beginnin2. at the anus. The anus itself may prove to be the source of trouble, or scybalous masses may be found immediately above it. Rectal examination with the finger and speculum may re-veal organic obstruc tions located immediately above the sphincter. In intussusception the in vaginated bowel sometimes reaches the anus. Enemas may be of assistance to
show the extent to which the lower bowel is free, but a powerful stream may prove dangerous if cancer be present; hence a douche-bag elevated but a few feet above the patient's buttocks had better be used.
the patient lying either on the back with hips raised or on the right side, or in the genu-pectoral position. The entire colon should contain 11/, gallons, but 1 gallon is about all that can usually be intro duced in the adult without force and if but a smaller quantity—sometimes but a few ounces—can be introduced, the evi dence may serve to strengthen the other signs. Examination by the introduction of the entire hand or by the rectal sound is not a safe procedure. Forced inflation by means of bellows or bicarbonate of soda and tartaric acid may also be tried, but not when cancer is thought to be present.
In obstruction of the colon tenesmus is frequently present, while mucus and blood are commonly passed; emaciation and general collapse do not occur as early as in occlusion of the small intestine, while the flow of urine is not greatly re duced. A digital vaginal examination sometimes affords further information.
In obstruction of the duodenum or jejunum the abdomen is not, as a rule, distended; vomiting occurs early; col lapse is rapid; and the flow of urine usually ceases early. Palpation may be deceptive in this location, the portion of intestine below the seat of the obstruc tion often sinking into the pelvis and dragging the stenosed intestine some dis tance below its normal situation and be yond reach.
The sign which to personal mind is of the greatest si,?.iiificance hi the diagnosis of intestinal obstruction is the impor tance of an empty rectmn as sliggestive of intestinal obstruction 101C» there has been no movement of the bowels for sev eral days. The value of this sign is much increased if cathartics and ene mata have been given previously with out satisfactory resnIts. Personal at tention was first called to this sign many years ago when a man about 40 years old, who bad abdominal pain and had had no movement of the bowels for three days, was seen. He had taken several doses 4-4 cathartic medicine and numerous enemata without avail. No vomiting, no fever, no abdominal ten derness or spasm, and no rise of the pulse. Digital examination wa.s made on the ground that the trouble might be due to freees impacted in the rectum, but no Iteces wcre found, and the finger had a trace of blood on it when with drawn. Two days later the man was operated upon and a complete obstruc tion of the bowel was found dependent upon a volvulus.