HOW TO EXAMINE THE PATIENT 23 



(3) By Rectal Exploration. — No grandiose afiecta- 

 tion of grandesse should cause the surgeon to neglect 

 this. Carefully and intelligently performed, it is one 

 of the grandest means at our disposal for arriving at 

 an accurate knowledge of the condition of the bowels. 

 The bladder and a large portion of the posterior masses 

 of intestines are well within reach, and the infor- 

 mation gained by their examination will be found in- 

 valuable. 



Notice should be taken as to the fulness or otherwise 

 of the rectum, of the consistence of the fgecal matter re- 

 moved, whether semi-fluid or hard and solid, whether 

 the removed lumps are covered with mucus or not, and 

 whether of normal odour or comparatively stinking and 

 offensive. 



It should be noticed also whether or not this organ is 

 open ('ballooned') or exerting a clinging movement on 

 the operator's arm. In cases of acute obstruction — 

 calculi, faecal matter, and twist — this clinging action will 

 be particularly noticeable, and, with it, the operator will 

 observe a painful straining on the part of his patient, 

 together with the presence of tympanitic or impacted 

 intestines in the pelvis. In many cases where this latter 

 has been observed the obstruction has turned out to be 

 in the single colon, and it may be taken as a general rule 

 that in any case where the pelvis contains other bowels 

 than the last portion of the rectum the practitioner has 

 a case of a dangerous nature to deal with. 



To the right the operator should feel the head of the 

 caecum and colon ; their contents should not be hard, and 

 on pressure the bowel should give ; to the left and 

 centre should be felt the pelvic flexure of the colon with 

 its elastic contents, and to the centre may be found some 

 of the small intestines. They should not be distended 



