110 
OBSTRUCTION OF THE BOWELS. 
further, and we must explore the terminating portion of the 
canal. We must examine the rectum with the finger, and 
if we discover nothing by that means we must make a further 
examination with a long tube and injections; but, in using 
the tube, we must bear in mind that it may be arrested by 
the pouches and folds of a lax rectum, or by the promontory 
of the sacrum, or by an enlarged uterus ; and while we think 
it is passing freely, it may be that it is only curling upon 
itself. Much care is necessary therefore in the performance 
of this kind of exploration ; and at best it only indicates that 
there is an obstruction, but does not reveal its nature, nor 
the propriety of an operation. Then, with regard to injec- 
tions, it must be borne in mind that although, when only a 
very small quantity is admitted, the presumption is that there 
is an obstruction near the anus, yet it may be that a good 
deal of fluid may pass through a very narrow opening. When 
our minds are made up that an obstruction exists, but we 
are unaware of its seat or its nature, we first have recourse to 
medical means of relief. And here a perfect comprehension 
of what means may be properly had recourse to, is of the last 
importance ; because I believe there is no class of cases in 
which the patient’s sufferings are so much aggravated by 
indiscreet treatment, or I might say by the treatment com- 
monly employed, as in those of intestinal obstruction. 
"It is usual to employ, from an early period, the most 
drastic purgatives, such as croton-oil ; and the common result 
is to aggravate the abdominal pain, and to induce the most 
distressing sickness sooner than it would otherwise happen. 
I am confident that, by abstaining from such means, as an 
ordinary rule, you will not lessen the chance of evacuating 
the bowels, and you will greatly lessen the patient’s distress. 
“ When constipation has resisted ordinary means, I think 
the proper course to take is to exhibit one or two full doses of 
calomel with opium — say eight or ten grains of calomel and a 
couple of grains of opium — and to exhibit large emollient 
enemata every six or eight hours. If these means fail, I am 
accustomed to endeavour to affect the system with mercury, 
by giving a couple of grains of calomel every two hours, 
combining with it opium if there be much pain, and asso- 
ciating with it external inunction. Upon what principle this 
is done it may be difficult to explain, for it can hardly be 
expected to burst a band or to relax a cancerous contrac- 
tion; but I believe, if the obstacle be a foreign body, it may 
be loosened by the increased secretion from the mucous 
surface ; and if it be a recent adhesion, it may be softened and 
detached by mercurial action. Certain it is, however, what- 
