Whatever may be the cause, or (from the duodenum to the rectum) whenever acute, persistent stricture of the lumen of the alimentary tract develops, there is created the gravest form of abdominal emergency.
Initial manifestations, as mild as a common, transient "gas colic," may progress so swiftly that but few hours suffice to accumulate pathologic changes of a degree and extent indicative of early death. Again, abrupt, stormy, painful beginning-symptoms, suggesting rapid and extensive enteric damage, often enough are followed by such quiescence of distress as to present a problem equally puzzling from the points of view of diagnosis and of management. In either type of onset, physical examination of the abdomen may yield few anomalies; the classic or textbook signs of intestinal obstruction are lacking or confused. Indeed, as our material shows, what most commonly are considered as signs of entero or colonic obstruction represent largely the manifestation of