OBSTRUCTION OF THE BOWELS. 429 



serious. What happens is often of this kind : A person thinks it expedient to 

 take some aperient medicine. This has no effect, and he repeats the dose. It 

 causes pain and griping, and probably sickness as well, but still the bowels are 

 unmoved. Then, perhaps, something stronger is tried, such as jalap, or calomel, 

 or eleterium, or croton-oil, or injections are given, but all in vain. The patient 

 is often conscious that food or medicines reach a certain spot, and there stop. 

 Very often they are rejected, or if they are retained they only serve to augment 

 the feeling of anxiety and distress. The abdomen gradually becomes distended, 

 especially if the patient is able to retain food. The intestines act powerfully, 

 and do their best to overcome the resistance, but their efforts are in vain, and 

 often give rise to the most agonising pain. Sometimes the great coils of 

 intestines can be made out through the abdominal wall rolling over and over 

 like a lot of snakes. Vomiting soon sets in, and eveiy thing may be rejected. 

 After a time the vomited matter becomes " stercoraceous," that is, it has the 

 odour and appearance of a motion. If relief cannot be afforded, the sufferings 

 of the patient are often very great, and his mental distress is agonising. In fatal 

 cases the mind is usually clear to the last, the sufferer's attention being intently 

 and distressingly riveted upon the possibility of obtaining relief. 



When the obstruction is in the upper part of the intestines, and our treatment 

 fails to remove it, death usually ensues in a period varying from five to ten days, 

 but when occlusion occurs lower down life may be prolonged for a mucji longer 

 period. Cases are on record of patients having lived on without any evacuation 

 of the bowels for four, or five, or even six weeks. It is in these protracted 

 cases that recovery occasionally occurs spontaneously. 



What should be the treatment of obstruction of the bowels 1 In the first 

 place, the attendance of a medical man is absolutely necessary in fact, we 

 know of no disease in which skilled assistance is of more importance. Whenever 

 there is obstinate constipation which cannot be overcome by ordinary purgatives, 

 you should bear in mind the possibility of there being some obstruction. If 

 you are in any doubt, send for the doctor. In any case in which you are 

 convinced that there is a mechanical obstruction to the use of the bowels, you 

 should at once cease giving purgatives. To persist in the use of powerful 

 purgatives under these circumstances is to inflict wanton and needless suffering 

 on the patient. You must remember that the bowel is already contracting 

 powerfully, and requires no stimulating. Rather should an endeavour be made 

 to moderate the propulsive force, and relax spasm by the administration of opium, 

 A dose of laudanum will often do more to relieve the patient's sufferings and 

 to produce an evacuation than any quantity of calomel or colocynth. 



With the view of averting, or at all events postponing, the distension of 

 the bowel above the seat of obstruction, it is necessary to limit the amount of 

 fluid taken by the mouth, and to regulate its kind. The nutriment should be 

 liquid, and small quantities only should be given at a time. Large injections 

 gradually and gently introduced into the bowel, and repeated three or four 

 times a day, often prove of great value. When the obstruction is due to some 

 hard mass, they may in time succeed in breaking it down, or. at all events by 



