CONTRACTIONS AND CLOSURES OF THE INTESTINAL CANAL. 589 



of hard faeces, such as vegetables, or bread containing much bran, or 

 even of badly-prepared asparagus, may induce this form of obstruction 

 of the intestines. 



ANATOMICAL APPEARANCES. It would take too long to speak in 

 detail of the different tumors that may compress the intestine. The 

 pathological anatomy of strictures of the intestine is entered into when 

 speaking of the different diseases that cause them. The change of 

 position of the intestines that causes closure of the intestines has been 

 previously described. 



Above contracted places we usually find the intestine dilated, and, 

 as it is at the same time elongated, it is abnormally curved. The 

 walls of these portions of intestine are usually hypertrophied, or at 

 least thickened ; the cavities are filled with gases and faeces. Below 

 the contraction the bowel appears empty and collapsed. Where gas 

 and faeces have rested for a time, the mucous membrane is usually in a. 

 state of chronic catarrh, which, from time to time, becomes acute (see 

 previous chapter). 



In closure of the intestine, its vessels, and in some cases those of 

 the mesentery also, are compressed ; in consequence of which there is 

 great capillary congestion, which induces decided swelling of the wall 

 of the intestine, severe catarrh of the intestinal mucous membrane, 

 transudations and small haemorrhages in the serous coat. More or less 

 extensive peritonitis usually accompanies these changes. If the pres- 

 sure and tension of the vessels be not removed, absolute stasis occurs 

 hi the capillaries, and, in consequence of this, mortification of the wall 

 of the intestine. In the latter case there may be a perforation, which 

 almost always causes death from peritonitis. In some few cases the 

 intestine becomes adherent to the abdominal wall before perforation, 

 and a fecal fistula or so-called artificial anus results ; these diseases 

 belong to the domain of surgery. In intussusception the mortification 

 of the invaginated part, and its passage through the anus, may effect 

 a relative cure, if a firm adhesion between the external and middle 

 layers of the intussusception have previously taken place ; but this 

 place usually remains permanently constricted. This is still more apt 

 to be the case if only the lower part of the invaginated intestine slough 

 off while the upper part becomes firmly adherent to the sheath, so that 

 at this point the intestinal wall shall permanently consist of several 

 superimposed layers. 



SYMPTOMS AND COURSE. The most important symptom of con- 

 striction of the intestine is difficult and tedious defecation. But, as 

 many persons suffer from sluggish bowels without any mechanical ob- 

 stacle impeding the progress of the contents of their bowels, it does 

 not appear improper to insert here some remarks on " habitual con- 

 stipation." 



