INTERNAL CONCRETIONS. 409 



death. AVben the bowels become inflamed, owing to the 

 presence of calculi, all the symptoms of enteritis are pre- 

 sented, as rolling, pawing, quick pulse, constant pain ; cold 

 sweats break out upon the body, and death follows. 



Treatment. — The practitioner should carefully examine as 

 to the state of the rectum. As a rule removal of the con- 

 tents of the rectum with the hand, or ' back-raking,' as it 

 is commonly called, is not to be recommended, as it may 

 give rise to a considerable amount of irritation, particularly 

 if performed in a careless manner, or if the operator pos- 

 sesses a large hand. But back-raking must be done under 

 certain circumstances, and this is one of the conditions in 

 which it may be productive of good results. Enemas of 

 tepid water and soap should be freely given. In case there is 

 much pain opiates should be administered, and the calculus 

 may pass on until it enters the rectum and comes within 

 reach of the hand, when injections of tepid water may be 

 given to empty the rectum of faeces, after which, the hand 

 and arm should be thoroughly lubricated with vaseline, lard, 

 or olive oil, and a quantity of oil may also be forced into 

 the rectum to lubricate its walls and facilitate the removal 

 of the calculus. The hand should now be gently passed into 

 the rectum and the calculus seized, and gently removed. 

 Purgatives are inadmissible, inasmuch as they are likely to 

 cause rupture of the bowels. 



CONSTIPATION. 



Constipation may be a symptom of disease, as of en- 

 teritis, pneumonia, etc. It is also observed when intestinal 

 concretions are present in the bowels. It is an undue 

 accumulation of faeces, and may be due to too great or 

 rapid absorption of the fluids of the intestinal canal, 

 as is often the case in febrile disoiders. Derangement 



