574 AFFECTIONS OF THE INTESTINAL CANAL. 



tines entering the stomach cause severe irritation ; nausea and 

 vomiting occur ; at first the food in the stomach is vomited, then 

 green, bitter, bilious masses, and in rare cases a brownish fluid of 

 disagreeable taste and feculent odor (ileus, miserere). 



From these symptoms, we may be certain that an obstruction 

 to the progress of the contents of the intestines has occurred at 

 some point ; in the few cases where the pains in the right iliac 

 fossa are slight, and when no tumor can be found there, we may 

 be unable to determine the nature of this obstruction ; but, in most 

 cases, besides the constipation, there are severe pain and a charac- 

 teristic tumor, which put an end to all doubt. The pains spread 

 over the right lower part of the abdomen are marked by severe ex- 

 acerbations, with intervals of comparative ease, and are increased 

 by the slightest pressure in this region, as well as by every motion. 

 On palpation, which the patients usually fear greatly, we feel a 

 tumor, which has a sausage-like shape, and extends from the right 

 iliac fossa toward the lower margin of the ribs. This tumor cor- 

 responds so exactly to the shape and position of the caecum and 

 ascending colon that it may be readily distinguished. [Its upper 

 border is usually on a level with the anterior superior spine of 

 the ileum or a little above ; the external border is about half an 

 inch to an inch and a half from this ; the lower border does not 

 usually reach to Poupart's ligament ; while the inner border ap- 

 proaches to within two or three inches of the median line of the 

 body. But we must bear in mind that exceptionally the caecum 

 lies higher, and, on the other hand, that it may lie nearer the en- 

 trance to the lesser pelvis, and may have crossed the median line to 

 the left.] 



Improvement begins in the above stage in favorable cases ; the 

 patient has several passages, with severe griping pains in the 

 bowels ; large masses of badly-smelling faeces are evacuated ; vom- 

 iting subsides, and the tumor decreases and disappears gradually, 

 as only part of it is due to the contents of the intestine, the rest 

 depending on the swelling of the wall of the intestine. 



But the disease does not always take this favorable course ; on 

 the contrary, in most cases, the inflammation extends from the 

 serous covering of the caecum and ascending colon to the peri- 

 tonaeum of the neighboring intestine and abdominal wall, and to 

 the connective tissue uniting the ascending colon to the iliac fascia. 

 From the extension of the peritonitis, the abdominal tenderness 

 becomes more diffuse, the swelling loses its peculiar sausage shape 

 and grows broader ; from the perityphlitis (inflammation of the 



