428 THE TREATMENT OF DISEASES. 



symptoms of obstruction fifteen or twenty days after gluttonously swallowing some 

 pounds of cherries, stones and all. He died, and on opening his body a mass of 

 cherry-stones, almost as big as a man's fist, was found completely blocking up the 

 bowels. Sometimes a large gall-stone may prove fatal in a similar way. Insoluble 

 matters in the form of powders or of fibres when habitually swallowed, even in 

 small quantities, are often concocted into hard masses. Sometimes a collection of 

 purgative pills may give rise to trouble. It is astonishing, however, what a lot of 

 pills some people will swallow without seeming any the worse for it. In a recent 

 breach of promise case it transpired that the defendant, a clergyman, had taken five 

 pills a day for a period of over thirty years and he survived. Round-worms have 

 been known to cause obstruction ; sometimes there are great numbers of them, and 

 they may be twisted up together so as to form a big ball. If in such a case it were 

 possible to ascertain the nature of the obstruction, probably little difficulty would be 

 experienced in effecting a cure. 



Sometimes the obstruction is due to stricture of the bowel, and then the hopes of 

 a favourable termination are indeed small. The stricture may possibly depend on 

 some condition of spasm which is merely temporary, but the contraction of the 

 bowel is far more likely to have risen from the healing of some old ulcer, or it may 

 be from the deposit of cancer or some other malignant growth in the wall of the 

 intestine. We have already seen that in typhoid fever we get ulceration of the 

 bowel, but fortunately the healing of these ulcers seldom or never give rise to 

 stricture, probably because they are too small. Children are sometimes born with 

 stricture of the bowel, or even without any passage. 



Occasionally the bowel is obstructed by something pressing on it from the outside. 

 In rare cases there has been some tumour connected with the womb or some other 

 organ which has given rise to the mischief. Sometimes the bowel may become what is 

 called " strangulated," or constricted internally, a knuckle of the bowel being nipped 

 in some little hole in the tissue so that nothing can pass through it. In other cases, 

 what we call "intussusception," or " imagination," takes place, one part of the 

 bowel being drawn into another portion, just as the finger of a glove can be made 

 to glide within itself. The passage of the gut then gets more or less obstructed by 

 the congestion and inflammation which result. Usually the intussusception is single, 

 though three or four, or even ten, distinct invaginations have been found in the 

 same subject. This kind of obstruction is most common in children, and also in old 

 age. Perhaps one of the most frequent causes of obstruction is a rupture, and 

 consequently in every case of obstinate constipation a careful examination would 

 have to be instituted by the doctor of those parts of the abdomen, thigh, and hip 

 through which the intestines could protrude. 



Such are the chief causes of this fearful malady, and we should be thankful that 

 the complaint is not more common, for there are few cases of disease more painful 

 to witness than those resulting from invincible obstruction and closure of the 

 intestinal tube. 



Next as to the symptoms. Sometimes the attack is quite sudden, and the 

 patient experiences a sensation as if something had gone wrong in his inside. 

 At others the onset is gradual, and there is nothing to indicate anything at all 



