CONTRACTIONS AND CLOSURES OF THE INTESTINAL CANAL. 597 



the patient on a .diet which will leave as little faeces as possible. The 

 more threatening the symptoms of the constriction, the more necessary 

 it becomes that the patient should live on eggs, strong broths, and 

 pure muscular meat, with delicate fibre. At the same time, we must 

 secure regular evacuations by enemata and laxatives. 



Those cases of obstruction of the intestine that are caused by hard- 

 ened faeces and stony concretions are far more amenable to treatment 

 than those caused by changed position of the intestines. This is par- 

 ticularly true of the obstructions of the rectum by faeces, which are 

 often collected in astonishing masses above the sphincter. A prudish 

 physician, who does not venture to ask for a local examination, will 

 prescribe laxative after laxative for days, in such cases, without any 

 benefit; while a physician who has no false modesty, and takes no 

 refusal when it is a question of knowing the disease more thoroughly, 

 obtains wonderful results. It often requires great pains and untiring 

 patience to make a passage with the finger, the handle of a spoon, or 

 corn-tongs, for enemata which, at first, would not enter, and to pass an 

 elastic tube through these masses, and give softening enemata. The 

 task becomes more difficult if the hardened faeces be higher up. We 

 may here refer to what we said of the removal of impacted faeces when 

 speaking of the treatment of typhlitis stercoralis. At first we attempt 

 to induce a passage by a few spoonfuls of castor-oil, or by large doses 

 of calomel ; to each dose of the former we may add half a drop of 

 croton-oil. If these remedies prove ineffectual, and increase the vomit- 

 ing, we should confine ourselves to the use of the clysopompe [Davi- 

 son's syringe], which certainly offers the most chance of softening the 

 hard masses which are usually in the large intestine. 2 We must not 

 be discouraged if the first injection does not produce an effect, but 

 must repeat it two or three times daily. In one case that I have seen, 

 it was not till after four days' assiduous use of the pump that small, 

 friable, greatly-discolored masses of faeces, which had a horrible odor, 

 were mixed with the fluid injected. And not till the following day 

 were there large quantities of similar appearance. In desperate cases 

 we may use pure quicksilver ; from a few ounces to a pound or more 

 of this article may be swallowed. It cannot be denied that, in some 

 cases, where all other remedies failed, the weight of the mercury broke 

 through the obstruction. Rotations and internal strangulations can 

 rarely be diagnosticated with sufficient certainty to justify gastrotomy, 

 which, to be successful, should be performed as early as possible. It 

 is not impossible that quicksilver may, by its weight, remove a rota- 

 tion of the intestine, or cause the reposition of a strangulated part by 

 the traction that it exercises on it before reaching it ; however, there 

 is some doubt about the diagnosis of the cases where this result is said 



