The muscular fibres of the intestines are circular and longitudinal. In the large intestine the longitudinal fibres are shorter than the tube itself, which length permits the formation of loculi (cavities). These become the seat of fæcal accumulations, only too often unnoticed by the physician. It is undoubtedly a fact that the loculi of the colon contain small fæcal accumulations extending over weeks, months, or even years. Their presence produces symptoms varying all the way from a little catarrhal irritation up to the most diverse, and in some instances serious, reflex disturbances. When the loculi only are filled, the main channel of the colon is undisturbed. The most common parts of the colon to become enlarged are the sigmoid flexure and the cæcum (see diagram in beginning of book), but accumulations may occur in any part of the colon. The ascending colon is much more often filled in life than the books would lead us to believe; indeed, it may be said that chronic accumulations are oftener to be found in the ascending than in the descending colon, which is also contrary to the assertions of the authors. This is due partly to the fact that the contents of the colon have to rise in opposition to gravity, and partly to the semi-paralyzed condition of the muscular coat of the colon through inactivity. When the accumulations are large, the increased weight of the colon tends to displace it; and if in the transverse colon, that portion may be depressed, even into the pelvis. The mass may be so enormous as to press upon any organ located in the abdomen, interfering with its functions; thus we may have pressure on the liver that arrests the flow of bile; or, upon the urinary organs, crippling their functions. Of course, such excessive accumulations occur only exceptionally, and it is not to these that attention is particularly drawn, because when they are so excessive, any physician can detect them by palpation (touch). It is to the minor accumulations particularly, that I wish to draw attention--the accumulations that we see in the majority of patients who visit our offices. Such patients assure us that the bowels move daily, but the color of their complexions, and the condition of their tongues, are enough to assure us that they are the victims of costiveness. Daily movements of the bowels are no sign that the colon is not impacted; in fact, the worst cases of costiveness that we ever see are those in which daily movements of the bowels occur. The diagnosis of fæcal accumulations is facilitated by inquiring as to the color of the daily discharges. A black or a very dark green color almost always indicates that the fæces are ancient. Prompt discharge of food refuse is indicated by more or less yellow color. It would be interesting to inquire why fresh fæces are yellow and ancient fæces are dark.