606 AFFECTIONS OF THE INTESTINAL CANAL. 



ehexia appear ; there are a rapid loss of strength, great emaciation, and 

 a dirty complexion. These symptoms give a presumption for the can- 

 cerous nature of the obstruction. If the emaciation increases, and an 

 uneven, nodular, hard, painful tumor, which is at first movable, can be 

 felt deep in the abdomen, through the thin abdominal walls, there will 

 no longer be any doubt about the diagnosis. 



If, as is frequently the case, the cancer be in the rectum, or even a 

 few inches above it, the patients complain of severe pain about the 

 sacrum, extending to the back and thighs. The significance of these 

 sacral and spinal pains is often undervalued for a long while, and they 

 are regarded as symptoms of a disease free from danger, particularly 

 when there is at the same time varicose dilatation of the haemorrhoidal 

 veins, and a passage of bloody mucus from the intestine. But, grad- 

 ually, the increasing constipation and the peculiar appearance of the 

 faeces become suspicious. The latter have a very small diameter, are 

 sometimes round, again flat and ribbon-like, or are small balls, like 

 sheep's dung. These passages are at first mucous and glairy, subse- 

 quently they are covered with blood and pus, and they are evacuated 

 with constantly-increasing pain, which finally becomes excessive. Oc- 

 casionally the passages occur more readily, after the cancer breaks 

 down, or, instead of constipation, there may be diarrhoea, which can- 

 not be checked. At the same time there are often abundant haemor- 

 rhages, and during the intervals between defecation a discolored, stink- 

 ing fluid flows from the rectum, corroding the anus and its vicinity. 

 If the wall of the rectum be perforated, and the ulceration advance to 

 the vagina and bladder, there is a most fearful destruction and a most 

 miserable condition. The description of this and the directions for ex- 

 amining the rectum with the finger and the speculum, which give the 

 most reliable information, we leave to works on surgery. 



With few exceptions, of which we have already spoken, the course 

 of cancer of the intestine is rather tedious ; it always terminates in 

 death. The latter sometimes occurs with the symptoms of ileus, which 

 appear gradually or suddenly ; sometimes with the symptoms of ex- 

 cessive marasmus, which is occasionally accompanied, at the last, by 

 dropsy and thrombus of the veins ; sometimes death is hastened by 

 peritonitis, which may occur with or without perforation of the intes- 

 tine. 



TREATMENT. The treatment of cancer of the intestine can only be 

 palliative. We must try to regulate the diet, so that as little faeces 

 as possible shall be formed ; it is best to nourish the patient with con- 

 centrated broths, soft-boiled eggs, and milk. We should most stren- 

 uously insist on a daily evacuation of the bowels, and, for this purpose, 

 ghould prescribe laxatives which act certainly, and with as little irri 



