Inspection reveals eitner s symmetrical fulness of the abdomen (sometimes barrel shaped) or a protrusion of certain parts. Thus, as mentioned above, the upper part of the abdomen is protruded when the occlusion involves the duodenum or the upper part of the jejunum. The right iliac region is intensely tympanitic if the occlusion involves the hepatic flexure, while the left iliac region is the seat of the protrusion if the occlusion involves some portion of the descending colon. After the disease has existed for some days there is as a rule a general marked swelling of the abdomen.

Palpation reveals in some cases a circumscribed area which is painful on pressure and thus serves to localize the seat of the disease. This is especially the case very soon after the onset of the symptoms. In the larger number of cases, however, there is a special tenderness either in the region of the navel alone or over the entire abdomen. In comparatively few cases will palpation reveal a tumor situated deeply within the abdomen and in direct connection with the site of obstruction. This occurs especially in intussusception, strangulation, in occlusions due to compression by tumors, and in fecal impaction. After a thorough palpation of the abdomen a digital examination of the rectum and also of the vagina should be performed. It is hardly necessary to add that a thorough examination should be made of any existing hernia which may be the seat of incarceration.

By means of auscultation either from a distance or in the immediate neighborhood of the abdomen we are often enabled to judge about the state of the intestinal peristalsis; for when the latter takes place in a violent manner splashing and gurgling noises are always audible.

Percussion is usually of great importance. In general meteorism it permits us to judge of the position of the diaphragm and liver. If percussion shows a change in character over a certain region of the abdomen during a period of a few minutes, it follows that the condition of an intestinal coil lying beneath has undergone some change in its state of fulness, and thus indicates that the bowel is still in active peristalsis. Auscultation and percussion may be used conjointly and serve the same purpose. In case no change whatever is noted on percussion for a very long period of time, there is a suspicion that paralysis of the bowels exists. The liver dulness will be found either partly or entirely absent in almost all cases of perforation, but in Some rare instances even without perforation. In the latter event we must assume that intestinal coils filled with gas are lying above the liver. I have observed such a case with recovery during the last year. Sometimes percussion may help to discover existing exudation, dulness being found in the lower part of the abdomen.

Examination of the vomited matter will show the presence or absence of fecal elements. The urine is scanty, very concentrated, often contains albumin, and almost always shows an increase of indican and phenol. Rosen-bach's reaction is almost always present.