IMPACTION OF THE CECUM 97 



which the ingesta pass as through a tube and are carried 

 along by the perstaltic movements of the bowel walls, the 

 proposition is entirely different. In a case of this kind 

 it is easy to see that fluids taken by mouth or secreted 

 by the intestines would be carried along to the solid 

 mass, which upon being softened by the mechanical ac- 

 tion of these liquids, could be moved on by the action 

 of a peristaltic stimulant. 



On the other hand, in the case of the cecum, we have 

 what may be practically termed a blind pouch, and we 

 may not depend upon this, what I choose to term, washing 

 action of the fluids. 



In the tube-like intestine, the liquid with peristalsis 

 forcing it along, must work its way into the impaction 

 and disintegrate it. 



But in the case of the cecum, when we have this 

 large reservoir entirely filled with an impacted mass, it 

 seems to me that the most natural course for any fluids 

 entering through the illeo-cecal valve is directly out by 

 way of the nearby entrance of the colon. This theoretic 

 sudden discharge of an abnormally large quantity of 

 liquid into the colon, I think, accounts for the prodromic 

 diarrhea described by Gofton and later by Reeks. 



So far as I could determine, this looseness of the 

 bowels did not precede my cases but I thiiik that I saw 

 its counterpart in the acute colicky symptoms shown at 

 the onset of the attack, which I attribute to the colon's 

 receiving this unusual quantity of ingesta whose ingredi- 

 ents were not of a type upon which the colon is capable 

 of acting. Consequently fermentation, rather than di- 

 gestion, ensued and flatulence was the consequence. 



