CONTRACTIONS AND CLOSURES OF THE INTESTINAL CANAL. 593 



amine the rectum with the finger. If we can reach no stricture with 

 the finger, we should use an elastic catheter. We may be deceived by 

 the catheter striking against the promontory of the sacrum, or by a 

 fold in the wall of the intestine, preventing the further entrance of the 

 instrument. Spasmodic contractions of the rectum may also deceive 

 unaccustomed observers. In women it is just as important to make a 

 vaginal examination, to satisfy ourselves about the position, size, and 

 form of the uterus, and find if there be any tumors in the pelvis. 



The symptoms of closure of the intestines, which subsequently be- 

 come terrible, and very dangerous, are often slight, and apparently 

 free from danger at the outset. The patients feel puffed up, have colic, 

 periodically appearing and disappearing, think they have made some 

 error in diet, and take some camomile-tea, or a slight laxative. The 

 physician is not usually called till these remedies fail, and, in spite of 

 them, the pains increase, and the bowels do not move, or when nausea 

 and vomiting occur. A careful and experienced physician always con- 

 siders this combination of symptoms as disagreeable and threatening. 

 The first thing to do is carefully, without over-modesty or forbearance, 

 to examine those parts of the body where hernia may occur. Woe to 

 him who trusts that the patient will, unquestioned, tell him he has a 

 rupture, or who rests contented with his simple denial of the question ! 

 The rectum and vagina should be explored just as carefully as the in- 

 guinal regions, to find if there be any obstructions to the evacuation 

 of the bowels. In spite of the anxiety that the case causes him, the 

 physician, of course, hopes, at this time, that the symptoms are excited 

 by a retention of faeces, somewhat obstinate, perhaps, but one which 

 may, nevertheless, be overcome. He prescribes enemata, and large 

 doses of castor-oil, with the addition of a little croton-oil. After a few 

 hours he returns, uncalled for, to the bedside of the patient, for the 

 purpose of satisfying his own anxiety. Meanwhile, the enemata have 

 occasionally brought away a little faeces from the lower part of the in- 

 testine, but, in most cases, they have had no effect, or it has been im- 

 possible to give the patient an enema. In spite of the addition of 

 croton-oil, the castor-oil has remained ineffectual ; after taking it, the 

 patient has had great pain, and frequently vomited green masses. At 

 the same time, his appearance has changed ; his face is distorted and 

 pale, the skin, particularly on the hands, is cool, the pulse small. Now 

 the sorrowful conclusion becomes more and more certain, that the in 

 testine is closed, and, perhaps, is so obstructed that medical aid can 

 give no relief. The abdomen gradually becomes more prominent; 

 there are severe, straining, bearing-down pains, which the patient calls 

 cramps. These paroxysms of pain are usually followed by nausea, and, 

 to the terror of the patient and those around him, the vomited masses 



