SUBACUTE OBSTRUCTION OF THE PELVIC FLEXURE 131 



that, if only in separately small quantities, some con- 

 siderable amount of fasces, when taken in the bulk, has 

 been expelled, and this, too, during such time as the 

 'animal has plainly been suffering from obstruction. 



If he has not already done so, he is led at this stage 

 to explore the rectum. He finds it empty, open, and 

 ballooned. He finds further that, within easy reach of 

 his arm, his hand comes into contact with a portion of 

 impacted intestine of considerable size, which leads him 

 at once to a correct understanding of his case. 



Diagnosis. — This is arrived at by further manipula- 

 tion of the impacted bowel. The surgeon finds that, 

 although larger in size, and probably not so angular, it is 

 comparable in shape to the flexed knee of a man pushed 

 there towards him. What he is feeling is the impacted 

 pelvic flexure. That at its point of constriction (see 

 where the number 5 is placed on Fig. 8) represents the 

 knee ; and the surgeon, passing from one side to the 

 other of this central point, makes out with the flat of his 

 hand the rounded and engorged portions of the bowel, 

 which, to heighten the rough simile he has already 

 framed, he may compare to the calf and the thigh of the 

 flexed imaginary limb. 



In other cases, according to the position the impacted 

 bowel has taken up, it suggests to the exploring hand 

 the further simile of a partly developed fcetus. This is 

 the more noticeable when, by reason of its increased size 

 or other cause, the whole thing has taken up a more 

 central position than is normal. 



As to the nature of the contents, these are quite hard, 

 and can only with difficulty be indented with the fingeis 

 pressing on them. 



Inasmuch as that in the following chapter I shall deal 

 with a further form of obstruction which may also be 



9—2 



