Through the Kindness of the past and present
memhers on the staff of the SicK ohildren's Hospi.tal,
Great Orraond street, I have l^een allowed to collect
and analyse all the cases of intussusception which
have been treated in the Hospital since that charity
As my connection with the Hospital has extended
over a period of two years, I have been enabled to
observe the disease myself on about 30 occasions.
Although I have dealt chiefly with the intussusceptions
of chiidren, I have not hesitated to draw on
the accounts of the disease as met with in adults,
in order to illustrate many points in the nature of
the affection, which either have not passed under
my clinical Knowledge, or reports of which I have
failed to find in the medical papers.
The literature on the subject of intussusceptions
is already so voluminous, that one can scarcely
hope to add much that is new. Nevertheless I have,
in this essay, made bold to state the belief that
ileo-colic intussusceptions, as at present understood,
never occur. I have attempted to prove that
they are really enteric intussusceptions which have
started a short way above the valve and then passed
through it in the ordinary way. That is to say all
intussusceptions grow by the saine common mechanism
and no special mechanism, of prolapse with a constant
ly changing apex, need be brought into play to explain
ths ileo-colic form, see pp. 5 to 14. I
believe therefore, that there are only three forms'.—
ileo-caecal, enteric^and colic,in that order of frequency.
I have pointed out what I believe to be
the true significance of the diiaple so often found
as the result of intussusception,and not,as is so
often supposed, the cause of this disease. (p.16 et
I have endeavoured to shew that in my cases
and in those of raany other writers, the invagination
starts more frequently in the ileum than in the
The anatomical facts here stated, are the
results of observations rnade ia a large number of
children in the pathological department of the hospital
(p. 69). The experimental worh was carried
out under Professor starling at University College,
London. A licence to conduct operations on living
animals was held from the Home Office, together with
certificate E.E.to allow the aniraals to he kept
alive afterwards. This latter was however never
used. in connectlon with these particuiar experiraents
Although the experiraents were not as conclusive
as I had hoped, they were very suggestive as to how
the invagination starts.
I have given an analysis of the age incidence,
sex, and cliraatic influences, of a large number of
consecutive cases in chiidren; and endeavoured to
explain the disproportion of male to females on
anatomical grounds (p. 97 to 105).
The exciting causes have been fully detailed
(p. 116 to 130). The presence arfl. influence of
Meckel's diverticulum has been fully entered into.
A resurae has been given of all the reported cases
in which the appendix seeraed to have been the
startlng point of the disease.
The existing accounts of the syraptoms,signs,
and diagnosis, leaves little or nothing to which new
can be added. Under the heading of differential
diagnosis I have detailed an interesting case of
purpura which could not be distinguished from the
affection now under conBideration, p.152. The
treatment has heen conaidered from nature's standpoint
as well as from that of surgery. An atterapt
has been raade to give a short historical account of
the treatment of the disease frora. the earliest tiraes
It is necessarily very incoraplete. But accounts of
successful surgical treatment are presented,dating
as far "back as A.D. 1672. The accounts were culled
from books and raanuscripts in the library of the
The deaths in my series are more proininent than
they should be. Soine of the earlier surgical notebooks
of the Hospital are raissing or incomplete, so
that the records of those cases nvhich recovered are
lost t-o rae. On the other hand, the post mortera
records have, from the very commencernent, been raost
faith.fullj'- written up, so that every ease which has
died frora this disease finds a place in ray series.
While these facts raay render my cases fallacious in
calculating the percentage of recoveries, it makes
thera raore valuable as a reeord of the raore complicated
and fatal forms of the disease.
Volume II contains the notes in full of the
cases discussed in this thesis. They are nurabered
aooording to their date.
The figurea, diagraras and charts used to illustrate
this worK were all drawn hy myself, with the
exoeption of sorae of the coloured plates for the
raore intricate of which the services of a profession
al artist were prooured.
The references to quotations I have endeavoured
to give in every case.