SUBACUTE OBSTRUCTION OF THE C^CUM 233 



quantity of fasces of medium consistence, proof that the 

 colon was not wholly inert, and that was all. 



Professor Gofton, however, with four cases to which 

 to refer, assures us that the impacted caecum is within 

 reach, and is to be recognized by the exploring hand. In 

 the account of one of his cases he says : 



' On a first rectal exploration the bowels, so far as 

 could be felt, were normal, and afforded no explanation 

 of the symptoms. On a further and more thorough 

 examination, the upper portion of the csecum could be 

 felt and easily recognized in the lumbar region, near the 

 centre of the abdomen, lying mainly on the right side, 

 but projecting a little over the middle line. The organ 

 was unusually prominent, its walls did not yield to the 

 hand as they do under normal conditions, and its con- 

 tents were firm and clearly not of the natural pea-soup 

 consistence. The full significance of this state of affairs 

 was not grasped at first, but it soon became clear that a 

 distended cascum, impacted with dry ingesta, accounted 

 for the course and symptoms of the case, and that the 

 purgative, though producing purgation, had failed to 

 influence the condition of the csecum.' 



When first reading that report, I was somewhat scepti- 

 cal as to the caecum being so certainly within reach. 

 However, a subsequent conversation with Professor 

 Gofton quite satisfied me that, in some of these cases at 

 any rate, such is the truth, and that, when so felt, this 

 condition of the caecum gives incontestable evidence of 

 the serious nature of the case. 



All that now remains to be said is that, even with the 

 true nature of the case revealed, treatment at present 

 seems to be useless. In spite of all that can be done, 

 this constant exhibition of dull pain prevails for some 

 seven to fourteen days. 



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