592 AFFECTIONS OF THE INTESTINAL CANAL. 



maining after frequent pregnancies, particularly after twins, appears tc 

 me much more injurious than the diminished activity of the abdominal 

 muscles. Such women, upon whose abdomen it seems cruel to press, 

 (rom a feeling that we should break through the walls, almost always 

 suffer from habitual constipation, and they cannot strain much ; and in 

 these same women there is always abdominal plethora and chronic 

 intestinal catarrh, which alone would sufficiently explain the retarded 

 defecation. (We may readily understand that, under these circum- 

 stances, a dilatation of the blood-vessels in the abdomen can easily 

 occur; when we consider that, normally, they are subjected not only 

 to the pressure of the atmosphere, but to that caused by the tension 

 of the abdominal walls, and consequently, when the latter are relaxed, 

 they are deprived of one important aid to the preservation of their 

 normal condition.) 



As habitual constipation, then, has so many causes, that its presence 

 alone does not justify the diagnosis of stricture of the intestine, the 

 question arises, How shall we recognize such a cause of constipation ? 

 The observation of the faeces may aid us here. In the ordinary forms 

 of constipation, sausage-shaped faeces, of extraordinary size, are often 

 passed ; in stricture of the intestine, on the contrary, particularly when 

 seated at the lower part of the intestine, they often have a very small 

 calibre, and consist of small rolls, scarcely as thick as the finger, or of 

 small round masses, like sheep's dung. Important as this symptom is 

 for the diagnosis of stricture of the intestine, we must still remember 

 that it may also occur after long starvation, particularly after long-con 

 tinued disease. The empty intestine, which is tightly contracted at 

 such times, appears to expand only gradually to its former calibre. 

 Even spasmodic contractions of the sphincter occasionally cause this 

 form of faeces. Hence, before we can diagnosticate stricture of the in- 

 testines from this symptom, the above states must be excluded. The 

 history may give another aid in diagnosis. We have already explained 

 that cicatricial contraction is the most frequent cause of stricture. 

 Hence, if habitual constipation and a peculiar form of the faeces occur 

 after a long attack of dysentery, or after diarrhoeas which seemed to 

 depend on ulcers of the intestine, the presumption is in favor of stric- 

 ture. In the same way, in other cases, we may suspect, from the his- 

 tory, that there is a retroversion of the uterus, or some kind of tumor 

 in the pelvis, which is compressing the intestine. In forming a diag- 

 nosis, we should also avail ourselves of physical examination. Promi- 

 nence of the abdomen at any part, and a remarkably full percussion 

 sound at this point, if found at repeated examinations, show that part 

 of the intestine, above a constricted portion, is dilated. Finally, when 

 we suspect stricture of the intestine, we should never neglect to ex- 



