INTESTINAL OBSTRUCTION. 127 
suffering from impairment, sharp slivers of very hard bones might remain un- 
dissolved, and cause much disturbance. 
Where the stoppage is complete, or nearly so, and the sufferer fails rapidly, 
it is possible to mistake the cause and assume the case to be one of poisoning 
by arsenic or other irritant poison; but a careful comparison of the symptoms 
presented in both accidents should prevent confusion, at least after the first few 
days. 
Many of the symptoms of peritonitis resemble those of stoppage, but in the 
former, vomiting is rarely frequent until late in the disease; moreover, there is 
not that unyielding constipation that exists in stoppage. Again, the signs of 
great constitutional disturbance, as high fever, rapid and weak pulse, etc., are 
manifested early in peritonitis, but late in stoppage. Finally, the victims of the 
former are apparently very sick from the first; whereas the symptoms manifested 
by those suffering from the latter only gradually become threatening. 
There remains one sign that occurs in quite a large proportion of cases of 
stoppage ; namely, the formation of a swelling or tumor in the abdomen. When 
this is noted with the symptoms already described there is scarcely room for 
mistaking the true nature of the existing trouble. 
Stoppage which gives rise to the most threatening symptoms, and is indeed 
the most dangerous, as arule, is high up in the intestines. Death seems imminent 
then, yet as long as there is life one may feel hopeful; for in some of the most 
desperate cases the obstruction has suddenly given way and recovery occurred. 
The cause of the stoppage being a splinter of bone or other foreign substance, 
and that having reached the lower bowel, as one can rightly assume to be the 
case when the discharges contain bright red blood and are attended by very evi- 
dent pain and much straining, it may be accepted that the chances are many 
that it will be safely expelled. 
In this connection it is well to call attention to the fact that where the 
obstruction is low down the abdomen is generally much more distended with 
gas or wind than when it is high up. To this, however, as to all other rules, 
there are exceptions. 
The existence of intestinal obstruction is scarcely likely to be determined 
until after purgatives have been given. These having failed, warm water may 
be injected slowly into the bowel until it runs away. The effect of such injec- 
tion is relaxing, and it may be decidedly beneficial, but unfortunately that is 
the case only in rare instances. 
Once the symptoms point to stoppage, the sufferer should be kept very quiet 
and given opiates, as directed in cases of colic. If they seem to indicate that 
the obstructing body is in the lower bowel, an injection of sweet-oil will be 
advisable. The oil should be warmed, to enable it to easily pass through the 
syringe; and it ought to be carried as far up as possible by means of a piece of 
rubber tubing drawn over the nozzle of the instrument. Convenience suggests 
