590 AFFECTIONS OF THE INTESTINAL CANAL. 



Henoch, who, In his clinic of abdominal diseases, treats very ex- 

 haustively of habitual constipation, and gives a very lifelike and accu- 

 rate account of the inconvenience to which it leads, says very truly that 

 u suffering from constipation " is a very relative term. Some persons 

 habitually only have a passage every second or third day, and still feel 

 very well, or feel worse when they have more ; on the other hand, 

 others feel sick if they do not have one or two stools daily. The 

 cause of this difference depends partly on the fact that the former form 

 but little faeces, as they eat food containing but little indigestible ma- 

 terial, and as they perfectly assimilate the digestible part of the food ; 

 while the latter have a quantity of faeces, because their food contains 

 much indigestible material, or because their power of digestion is im- 

 paired. 1 But even persons eating similar food and digesting equally 

 well show the same difference in the number of evacuations required 

 to keep them feeling well. It is difficult to give a satisfactory explana- 

 tion of these symptoms, but in most cases they seem to depend on the 

 fact that in some persons the irritation of the mucous membrane, by the 

 retained faeces and the products of decomposition, leads to intestinal 

 catarrh, while in other less susceptible persons the intestine remains 

 healthy. In the latter cases only small amounts of gases form from 

 the faeces contained in the intestines, the abdomen does not become 

 tense, and the diaphragm is not pressed upward, even when the person 

 has no passage for two or three days or more. In the former cases 

 the mucus covering the walls of the intestine acts on the contents of 

 the bowels as a ferment, and by their rapid decomposition quan- 

 tities of gas are formed ; the abdomen is puffed up, and, even after a 

 short retention of faeces, we have the inconvenience described in a pre- 

 vious chapter. To this description we have to add a few symptoms 

 that depend more directly on collection of faeces in the lower portions 

 of the bowels, particularly in the flexure of the colon and in the rectum. 

 Occasionally patients have an "unsatisfactory feeling," as Henoch 

 aptly calls it, after stool ; they feel as if there were still masses in the 

 intestines, which should have been passed. This feeling alone gives 

 them great discomfort, and puts them in a disagreeable frame of mind. 

 But, besides this, there are often symptoms resulting from the pressure 

 of the full intestines on the neighboring blood-vessels and nerves. 

 Pressure on the iliac veins rarely causes oedema of the feet; but 

 patients with habitual constipation usually suffer from cold feet, a very 

 annoying symptom, which is most readily explained by the impeded 

 return of the blood from the feet. Dilatation of tne vessels in the 

 walls of the rectum most frequently result from pressure on the hypo- 

 gastric veins, and occasionally there are ruptures of these dilated ves- 

 sels. The significance of these varicose vessels and the haemorrhages 



