This variety of intestinal obstruction is more common in females than in males and is usually met with in more advanced age and in patients suffering from hysteria and brain troubles. As a rule, the patients have already long before been subject to habitual constipation; usually many days elapse without an evacuation of the bowels. From time to time enormous quantities of fecal matter are passed 18 by artificial means. Later on the symptoms of constipation grow more intense. The abdomen becomes distended and it is much more difficult to secure an evacuation even by artificial means. As a rule the patient is tormented by eructations and flatulence. His appetite is poor; he has a bad taste in his mouth and frequently his breath has an unpleasant odor. Headache, vertigo, and a general tired feeling are often encountered.

These symptoms, as well as the marked unhealthy appearance of the skin, are most probably due to intestinal auto-intoxication. Certain chromogens, the products of decomposition, are absorbed from the bowel and give rise to this peculiar discoloration of the skin. The conjunctivae also are often yellow. A further symptom due most probably to the same process of auto-intoxication is the rise of temperature which is often present. If the distention of the abdomen is very marked, a feeling of oppression in the chest and palpitations of the heart are experienced.

Fecal accumulation sometimes causes pressure upon the lumbar or sacral nerves and gives rise to discomfort in the genital organs or to pain in the thigh radiating down the entire leg. Distended coils may be visible through the abdomen and there may be much rumbling and gurgling heard after constipation has lasted a long period. This symptom is, however, not so marked here as in cases of stricture of the intestine. Vomiting may occur and even become stercoraceous. Slight colicky pains are felt over the abdomen, but as a rule they are not intense.

The symptoms having advanced to an extreme degree, relief may ensue either spontaneously or after resort to different procedures which serve to evacuate the bowels. Occasionally, however, an evacuation of the bowel cannot be obtained and the patient develops all the symptoms of an Unyielding obstruction which may be fatal. Often there are attacks of obstruction following each other at certain intervals. The narrowed lumen of the bowel most probably becomes entirely occluded or blocked by a piece of hard fecal matter, which completely fills it and cannot move in either direction. Sometimes the abrupt stoppage may be due to some bending or kinking of the distended bowel.

In almost all cases of obstruction by fecal masses a tumor can be palpated usually in some portion of the colon. The tumor is caused by the fecal accumulation. The caecum, the hepatic and the sigmoid flexures are the places where the tumor is most often encountered. Such a fecal tumor feels hard and uneven; sometimes it has a globular shape. . As a rule it is not painful on pressure. Sometimes it is possible to change the shape of the tumor by pressure. This is the best proof of its fecal character. Sometimes, however, pressure does not give rise to any change in the configuration of the mass if the fecal matter is very hard. The best sign of its fecal nature is the change in form after repeated irrigations of the bowel. In some rare instances the fecal accumulation occupies the greater part of the abdominal cavity and gives the impression of one immense tumor of very hard consistency. I have seen two such cases in patients suffering from grave melancholia. Here also after repeated irrigations of the bowel and administration of cathartics the tumor gradually becomes smaller and ultimately disappears.