668 INTESTINAL OBSTRLX'TION. 



In all cases where there is a probability of external hernia, 

 ■every care must be exercised that such may not escape 

 detection. 



Treatment, — As it may not be possible in the greater number 

 of instances of obstruction from any of these causes, save where 

 external hernia is evidently the inducing factor — and then 

 the case resolves itself into one of reduction of the hernia by 

 manipulatory interference — to demonstrate to satisfaction 

 their existence, so our management of these is chiefly directed 

 to obtain mitigation of pain, the most distressing symptom, 

 and to relieve the bowel obstruction by favouring the natural 

 discharge of the contained material, or allowing it to retire to 

 the position previously occupied. Where from the previous 

 history of the case, and the intermittent character of the 

 symptoms, concretions are suspected, it is not wise, through 

 the exhibition of active purgatives, to attempt forcible dislodg- 

 ment of the obstruction. The employment of such anodjmes 

 as preparations of opium or belladonna, with bland fluids, and 

 the use of enemata, with the steady application, by means of 

 "woollen rugs, of heat and moisture, are nearly the extent to 

 which careful treatment may proceed. In every instance an 

 <3xamination of the rectum is advisable, seeing many cases 

 occur where obstructing materials there are within reach of 

 the hand, and by judicious manipulation may be removed. 



If a desire for food still exists, it must be given of such a 

 •character as will not aggravate the existing symptoms, and be 

 allowed in moderation. When pain is excessive and tympany 

 great, as in many of the cases of strangulation, the same 

 ■course is to be followed, with the addition probably, under 

 <3ertain circumstances, of the abstraction of blood and tapping 

 the distended bowel ; not that these are likely to be of much 

 benefit, but upon the principle that, being uncertain of the 

 •exact pathological conditions, Ave are still warranted in en- 

 deavouring to ward off death by relieving the more urgent 

 symptoms, not knowing what may result. 



Although not operating in inducing obstruction of the 

 bowels, it is under this group of disturbances, change in posi- 

 tion of the different parts of the intestine, that we ought to 

 place 



