SUBACUTE OBSTRUCTION OF THE CJECUM 235 



administration of the purgative. We shall know, then, 

 having seen the colon empty itself, that it is not to 

 impaction of that viscus we are now to look for the 

 reason of the pain's continuance. We shall have our 

 attention directed elsewhere, and that ' elsewhere,' simply 

 because the pains are of that subacute type associated 

 with impaction of one of the large bowels, will of neces- 

 sity be the caecum. 



Then will come the evidence obtained from rectal 

 exploration. ' A rectal examination,' says Professor 

 Gofton, ' permits of diagnosis without great difficulty, but 

 the continuance of the dull, uneasy condition and inappe- 

 tence after the action of the purge is not without a signi- 

 ficance which should lead to an examination of the 

 condition of the caecum.' 



This evidence, when obtainable, will be positive. That 

 in certain cases it will be obtainable Professor Gofton's 

 report makes clear. When giving me a verbal description 

 of it, he made matters even clearer. In fact, it seems to 

 me quite plain that we may come now to the ready diag- 

 nosis of another interesting form of intestinal obstruction 

 in the horse. 



Prognosis. — This, if not wholly unfavourable, must at 

 any rate be extremely guarded. Each of the cases re- 

 lated by Professor Gofton terminated in rupture of the 

 caecum, and death. In my own case the issue varied 

 only in regard to the seat of the rupture. In this instance 

 the first portion of the colon revealed a rent some 9 to 

 12 inches long. 



It would be most unwise, of course, with the very 

 limited knowledge we yet have of this condition, to state 

 point-blank that every case of impacted caecum ends in 

 death. I should not for a moment be inclined to believe 

 that. There is no reason that in every case a fatal ter- 



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