30 COLICS AND THEIR TREATMENT 



4. — Intussusception. — Intussusception is another 

 form of obstruction colic characterized by violent and 

 excrutiating pain ; it is also called invagination or indigi- 

 lation, and probably occurs with greater frequency than 

 is popularly supposed. Four forms of this classification 

 are listed among writers upon intussusception, viz. : First, 

 a telescoping of one portion of the small intestine into 

 another, ileal ; second, passage of the ileum, together 

 with the ileocecal valve, into the cecum, ileocecal; third, 

 passage of a portion of the large intestine into itself, 

 colic; and fourth, passage of the ileum into the opening 

 of the colon, ileocolic. 



Here the symptoms of pain incident to the convul- 

 sive contractions are closely allied to those detailed for 

 intestinal displacement, but with a somewhat longer dura- 

 tion; violent straining, often associated with the passage 

 of blood-stained particles of fecal matter. The ultimate 

 strangulation is less sudden, and the period of ease is 

 more protracted, prior to the excitement premonitory to 

 final collapse. In those cases of favorable termination 

 there may eventually be discovered in the alvine dis- 

 charges the cylindrical portion of the tract that has be- 

 come necrotic and sloughed off simultaneously with the 

 new union between the opposing peritoneal surfaces at 

 the anterior circumference of the prolapsed portion. 



5. — Obstruction of Small Colon. — During my 

 references to overloading of the small intestines the re- 

 mark was made that it "presents a line of symptoms not 

 unlike those observed with obstruction of the floating 

 colon" and "careful rectal examination gives basis for 

 differentiation." This must be borne in mind now that 



