Synii^toms, 405 



curs. In the severe type signs of restlessness, (Uffering in 

 intensity and the intervals between them, are likewise observed; 

 they are, however, accompanied by nnnatural positions, partic- 

 ularly in consequence of early bloating. The abdomen often 

 becomes distended at the beginning of the affection, because 

 circulatory disturbances develop first in the large intestine; 

 the small intestines and the small colon do not increase the 

 abdominal circumference, even if bloated, or only very slightly 

 on account of their comparatively small size. The intestinal 

 sounds are loud in the beginning for one or two or sometimes 

 for several hours ; they become less frequent and disappear en- 

 tirely ; the more rapidly the bloating of the intestines develops 

 and the more profound the circulatory disturbances, the earlier 

 do the intestinal sounds disappear. The percussion sound 

 either remains normal or becomes louder in consequence of the 

 bloating (see page 360). 



According to the behavior of the intestinal contractions 

 defecation may be observed for a few or even for several hours, 

 but then constipation becomes complete and feces and gases are 

 no longer discharged. The feces are softer and in very rare 

 cases mixed with blood. The authors saw blood in the feces in 

 only three out of more than 200 cases of thrombotic-embolic 

 obstruction. 



Rectal exploration shows a high degree of bloating in some 

 portions of the intestines (meteorismus localis s. circumscrip- 

 tus), usually affecting the colon, the cecum or both simultane- 

 ously or some loops of small intestines. The affected bowel is 

 much dilated, its wall very tense, elastic and not painful. In 

 bloating of the colon its left lower portion is enormously dis- 

 tended, not rarely reaches as high as the left kidney and dis- 

 places the left upper portion towards the median line or on the 

 contrary towards the left, sometimes even more or less down- 

 w^ard, especially when the cecum is liloated simultaneously. 

 The pelvic flexure is displaced into the pelvis or into the right 

 half of the abdominal cavity and the longitudinal l)ands of the 

 left lower portion of the colon run from left to right, occasion- 

 ally in a perfect spiral arrangement. The base of the bloated 

 cecum reaches into the left half of the abdominal cavity and 

 posteriorly into the entrance of the pelvis ; the base of the cecum 

 can be recognized as such by a longitudinal band running from 

 the right flank at first backward, then downward and to the left, 

 finally towards the thorax. The bloated loops of small intes- 

 tines present as arm-thick tense, elastic, sausagelike formations, 

 also the small colon ; the latter, however, displays a longitudinal 

 band along its surface. The other loops of intestines usuall)^ 

 preserve their normal size until the end in contradistinction to 

 the bloated bowels. The findings in the mesenteric vessels are 

 the same as those in the milder form of the affection. 



The pulse becomes weaker one to two hours after the 

 onset and rises to sixty beats per minute. Respiration and 



