594 AFFECTIONS OF THE INTESTINAL CANAL. 



constantly become browner and more discolored, and the smell more 

 distinctly feculent. There has been much dispute as to whether ster- 

 coraceous vomiting could result from obstruction of the small intestine, 

 or if it could only occur in closure of the large intestine, where the 

 formation of the fasces proper begins. We should bear in mind that 

 even the contents of the ileum, particularly if they have been there 

 long, may have a feculent odor, and that in so-called fecal vomiting 

 actual faeces are rarely, if ever, vomited. I consider it improbable that 

 the contents of the large intestine should pass the ileo-ccecal valve, 

 and enter the small intestine and stomach. There are various views, 

 even, concerning the origin of retrograde movements of the contents 

 of the intestine. JSetz not only denies all influence of the contractions 

 of the intestines on the backward movement of the contents, but he 

 even believes that they rather impede than aid the normal progress of 

 the contents from the stomach toward the rectum. In the act of 

 vomiting, abdominal pressure unmistakably plays the chief part ; it is 

 this, aided by the above-mentioned contraction of the pyloric portion 

 of the stomach, which evacuates its contents. The contents of the in- 

 testines appear to enter the stomach, because, during the contraction 

 of the intestines, the masses cannot pass downward, and are driven 

 upward. We will not discuss the question as to whether this occurs 

 regularly, or whether the contraction of one portion of intestine imme- 

 diately follows the contraction of the portion just below it that is, 

 whether there be an actual antiperistaltic motion. At all events, it is 

 evident that, as long as the obstruction exists, all drastics, by increasing 

 the contraction of the intestines, must induce vomiting. In some cases 

 the disease runs along for eight to fourteen days, or longer, with these 

 symptoms, which may even temporarily remit. During the attacks of 

 pain which usually precede the vomiting, according to Watson's graphic 

 description, we may feel or see in the abdomen " immense coils of in- 

 testine, as big, perhaps, as one's arm, rise and roll over, like some huge 

 snake, with loud roarings and flatulence. The distended bowel strives 

 with all its power, but strives in vain, to overcome the opposing bar- 

 rier." The patient, now fearfully disfigured, has a ghostly look, a dirty 

 color, his face is covered with cold sweat, his hands cool, his pulse im- 

 perceptible, while the mind remains long unclouded ; finally, he dies 

 exhausted, with the symptoms of general paralysis. 



The picture is somewhat different when extensive peritonitis occurs 

 early in the obstruction. Then the abdomen is puffed up much sooner ; 

 it becomes excessively tense, and so painful that even the slightest 

 pressure is not borne. As the exudation occurs almost exclusively be- 

 tween the inflated intestines, it can rarely be recognized by the dull 

 (>ercussion-sound at the dependent parts of the abdomen. The patients 



