Chap, xvii.] ABDOMINAL VISCERA. 345 



comparatively flat, while the distension will be most 

 obvious in the two flanks and in the region just above 

 the umbilicus. Tumours of the transverse colon, and 

 of the lower two-thirds of the ascending and descend- 

 ing colon, can be well denned, even when of moderate 

 size, and in cases of intussusception the progress of the 

 mass along the colon can often be traced with great 

 ease, and the effects of enemata and other methods of 

 reduction carefully watched. The diameter of the large 

 intestine (excluding the rectum) gradually diminishes 

 from the caecum to the sigmoid flexure, the diameter 

 of the former being about two and a half inches, of the 

 latter one and a half inches. The narrowest part of this 

 segment of the bowel is at the point of junction of the 

 sigmoid flexure with the rectum, and it is significant 

 that it is at this point that stricture is the most 

 common. 



The tendency to stricture increases as one proceeds 

 downwards from the caecum to the anus. A stricture 

 is frequent in the descending colon, less frequent in the 

 transverse colon, while in the ascending colon it is 

 comparatively rare. Strictures are not uncommon 

 about the flexures of the bowel.* 



When gradually distended the colon may assume 

 enormous dimensions, and it will be readily understood 

 that in some cases of great fiscal accumulation the 

 thoracic organs may, with certain abdominal viscera, 

 be displaced. In one case, for example, the heart was 

 so displaced by the distended colon that the apex beat 

 was found to be one and a half inches above and one 

 inch to the inner side of the left nipple. When the 

 fajcal collection had been removed it returned to its 

 normal position. Thus it happens that a distended 

 colon is often associated with shortness of breath, with 

 palpitation, and other thoracic symptoms. 



* See "Intestinal Obstruction." By the Author. London, 

 MM* 



