Intestinal Calculi. — Enteroliths. — Bezoars. 327 



of obstruction of this narrower portions of the colon and rectum, 

 which may be absolute and persistent, leading to rupture and 

 death or a fatal inflammation on the one hand, or may end in 

 recovery on the other, in connection with a displacement onward 

 or backward of the calculus as the result of peristalsis or anti- 

 peristalsis. 



Symptoms. These are intermittent colics, each reaching a 

 climax and followed by a sudden recovery 51s the calculus is dis- 

 placed into a more spacious part of the colon. A .significant 

 feature is the complete obstruction, faeces being passed for a short 

 time at first and then suddenly and absolutely stopped. Coinci- 

 dent with this are tympany, violent colics, .straining, rollitig, sitting 

 on the haunches, perspirations, anxious countenance, and all the 

 symptoms of obstruction. 



Diagnosis is never quite certain unless the practitioner with his 

 oiled hand in the rectum can detect a hard stony mass obstruct- 

 ing the pelvic flexure of the double colon with a tense elastic dis- 

 tended bowel inimediatel}^ in front of it, or a similar hard ob- 

 struction of the terminal part of the floating colon with a similar 

 disten.sion in front of it. The pelvic flexure may, usually be felt 

 below and to the right at the entrance to the pelvis, and the 

 floating colon above, under the right, or more commonly the left 

 kidney. Calculi in the more spacious parts of the double colon 

 or in the caecum are inaccessible to manipulation. The feed 

 (bran, ground feed) will be suggestive, as will the occupation of 

 the proprietor (miller, baker). 



Treatment. This is rather a hopeless undertaking. No effec- 

 tive .solvent of the calculus can be given, and purgatives usually 

 increase the* danger by increasing the peristalsis and dangerously 

 distending the bowel above the point of obstruction. It is true 

 that this is sometimes followed by a temporary recovery the cal- 

 culus being loosened and falling back into the dilated portion of 

 the bowel. I/C.ss frequently the increase in the peristalsis forces on 

 a moderately .sized calculus to complete expulsion. It is a 

 desperate though .sometimes successful resort. A more rational 

 course of treatment is the dilation of the bowel back of the ob- 

 struction by copious mucilaginous, soapy or oleaginous enemata. 

 Trasbot suggests COj produced by injecting sodium bicarbonate 

 and tartaric acid. This may be .seconded by the hypodermic in- 



