586 AFFECTIONS OF THE INTESTINAL CANAL. 



a large meal. In both patients the disease has lasted several years. 

 I consider it as not improbable that these patients have an ulcer or a 

 cicatrix in the duodenum. 



Absence of vomiting speaks against stricture of the pylorus, but I 

 cannot with certainty exclude a constriction of the duodenum or com- 

 mencement of the jejunum caused by chronic partial peritonitis (see 

 Chapter HI.). 



If it be difficult to diagnosticate an open ulcer of the stomach from 

 one that has healed and left a contracting cicatrix, it is impossible to 

 distinguish between an open duodenal ulcer and a cicatrix. The peri- 

 tonitis caused by the perforation of a duodenal ulcer runs the same 

 course as one depending on perforation of an ulcer of the stomach, 

 only it appears to run its course more rapidly, perhaps from the mix- 

 ture of bile with the contents that escape into the abdomen. For the 

 symptoms resulting from perforation into the gall-bladder, or exter- 

 nally, I refer to the monograph of Krauss. 



TREATMENT. Perforating ulcers of the duodenum are to be treated 

 in the same way as perforating ulcers of the stomach ; by strict regula- 

 tion of the diet, the use of alkaline and alkaline-saline mineral waters, 

 particularly the warm springs of Karlsbad and Ems, and under some 

 circumstances by nitrate of bismuth, and nitrate of silver. If there be 

 severe cardialgia, narcotics are indispensable. 



CHAPTER III. 



CONTRACTIONS AND CLOSURES OP THE INTESTINAL CANAL. 



THE varied processes which induce constriction or closure of the 

 intestine are best treated of in the same chapter, as the greater part 

 of the symptoms excited by them are common to all. 



ETIOLOGY. 1. Contraction or closure of the intestine may result 

 from compression. The rectum is most frequently compressed either 

 by a retroverted uterus or a pelvic tumor, such as fibroid of the uterus, 

 ovarian cysts having an unusual location, or by tumors and abscesses 

 starting from the pelvic bones or other tissue. Occasionally an over- 

 filled or cancerous portion of intestine compresses the portions of in- 

 testine lying under it ; or a piece of mesentery, drawn down by the 

 intestine belonging to it, being hi a large hernial sac, compresses poi- 

 tions of intestine lying between it and the spinal column. 



2. Constriction of tne intestine may be caused by structural 

 changes of the wall of the intestine. The different forms of stricture 

 of the bowel come under this head. Those resulting from cicatrization 

 of intestinal ulcers, particularly the catarrhal, follicular, or dysenteric. 



