Since then a rectal examination has invariably been made in cases that sug gested obstruction of the bowel, and it is felt that au empty rectum is of great importance in the diagnosis of this con dition. The finding of blood is of great importance in corroborating the sus picion caused by the discovery that the rectum is free from freces. Henry Jack son (Boston Med. and Surg. Jour., Feb. 27, 1902).
When the emeum or the ileum is the seat of obstruction, the distension appears to involve the centre of the abdomen rather than the sides. The outline of the anterior portion of the small intestines may appear through the abdominal walls and present the "ladder pattern." The case progresses much more rapidly, fTcal vomiting occurring early.
All cases, without exception, should be examined for hernia, since fatal impac tion may follow the intrusion into the external ring or the obturator foramen of a comparatively small loop of intestine.
The nature of the obstruction must next be ascertained.
Mechanical ileus must be differentiated from ileus due to paralysis of the affer ent nerve, vascular ileus, dynamic ileus, post-operative ilcus, lead-colic ileus, ady namic ileus, septic ileus, paralytic ileus, reflex ileus. stra»gulated hernia, irritant poisoning. and perforative peritonitis. A careful consideration of the antecedent history enables one frequently to make an a,. unite diagnosis of the special va ,f dens in v. ,viVell ease, but too ITO oft.11 the differential diagnosis is made by the aid of laparotomy or a post 100rtt711 section.
In flew.: due to bands or adhesions flare is usually a history of plastic peri tonitis due to a hernia, a salpingitis, an appendicitis, or gall-stones; an ovari otomy, or some intra-abdominal opera tion that was followed by an abrasion of the endothelial coat of the intestine, and adhesions to an adjacent loop, or to an uncovered stump or pedicle that directs attention to compression from without. Post-operative dynamic ileus cannot be differentiated. In ileus due to compression of the bowel in a slit or opening, there may be a history of abdominal traumatism also.
In volvulus there is the age of the patient,—forty to sixty,--chronic consti pation, and the enormous early disten sion of the abdomen to guide one as to the location and probable cause of ob struction.
In intussusception there is the sudden on-et of symptoms during infancy,— childhood most frequently. The charac teristic tenes.mus and desire to evacuate the bowels, the mucoid, then muco sanguinolent stools; the marked exacer bations of peristalsis and pain; and the history of previous diarrhcea and ex ce..,ive peristalsis are typical signs. A lozenge-shaped tumor can be felt; obstruction from foreign bodies usually gives a fairly clear history of gall-stones, the swallowing of fruit-pits, the imbibi tion of magnesia and chalk for a long time, or obstipation. D. A. K. Steele (Annals of Surg., Apr., 1901).