Following points emphasized: (1) that a patient may suffer from fatal obstruc tion and not present the classical symp toms, (2) that the symptoms of obstruc tion vary with the site of the obstruc tion, (3) that early and definite diagnosis is essential, (4) that the use of aperients is likely to do harm, (5) that the ex hibition of opium is likely to mask the symptoms and to produce signs of im provement which are entirely delusive, (6) that the time during which opera tive treatment is likely to be successful is very short. (7) that the bowel must be evacuated at the time of the opera tion, otherwise the patient may be poisoğed by his own excrement, and (S) that it is probably safer to be content with colotomy or enterotomy where the bowel is .seriously damaged. R. C. Ells worth (Lancet, May 27, '99).
Extensive experience with irrigations of hot saline solution has shown that the method is unreliable, and he is now a whole-hearted advocate of abdominal section at the earliest possible moment in every ease of intussusception. Irriga tion and inflation are site)) doubtful methods that valuable time is lost, and if the bowel has become at all stiffened by inflammation it is impossible to over come the adhesions. So long as the
bowel remains invaginated, even to the slightest extent. the intussusception may recur. With the rarest exceptions recovery from an only takes place when the invagination is capable of easy and :simple reduction. Fifteen of 65 personal cases, needed ex cision of part of the bowel before the intestinal obstruction could be over come. Fourteen died and 1 recovered. ln 10 cases excision was performed be cause the bowel was gangrenous; in 4 cases because the softened tissues tore durino. manipulation. In 6 of the 15 cases an artificial anus was made; in 5 cases a Murphy button was employed. Twice Matinsell's operation was per formed, and once the intestine was united by a circular enterorrhaphy. D'..A.rey Powers (Clinical Journal, Aug. 14. 1901).
Many cases are brought to the surgeon so late that the patient is exhausted. An extensive laparotomy is out of the question under these circtunstances. Wharton advises a colostomy. The opening should be made in the sigmoid flexure, if it be certain that the obstruc tion be below that point, otherwise the abdomen should be incised in the right iliac region and the ct-ecum opened, if it be found distended.