SUBACUTE OBSTRUCTION OF THE DOUBLE COLON 77 



' subacute obstruction of the small intestine ' should 

 properly have been described first. I have my reasons, 

 however, for giving the obstruction of the double colon 

 prior place. Among them is the fact that it is this 

 particular variety that occurs most often in practice, and 

 has led to the terms ' impaction of the bowels ' and 

 ' stoppage of the bowels ' being so loosely applied to other 

 and distinct types. The word ' subacute ' is purposely 

 inserted in order to exclude such acute occlusions of the 

 bowels as partial or complete twist, strangulated hernia, 

 intussusception, etc. That being done, we are compelled 

 to a consideration of such disorders as are brought about 

 by any circumstance that causes a stationary or torpid 

 condition of the bowels, or the surcharging of the in- 

 testinal tract with bulky, indigestible food. 



The present chapter, then, is given over to the descrip- 

 tion of all obstructions of a subacute type that occur in 

 any position in the large or double colon, with which, 

 until differential means of diagnosis present themselves, 

 I include typhlitic or caecal impaction. 



Before coming to its actual description, it will be 

 necessary to further continue this definition. A reference 

 to Professor Friedberger's table in Chapter I. shows 

 plainly enough that it comes under the second division of 

 the essential form of true colic — i.e., colic consequent upon 

 anomahes of the intestinal contents. The question, then, 

 arises. Will it be (a) the colic produced by overfeeding, 

 or (b) the colic occasioned by stoppage in the intestinal 

 canal ? In my opinion, the definitions thus indicated 

 are, to a very great extent, interchangeable, for in the 

 colic I am about to describe (that occasioned by stoppage 

 in the intestinal canal, known commonly as impac- 

 tion of the intestines) there can be no doubt that over- 

 feeding is responsible for a great majority of the cases. 



