An essay on intussusception: with an account and analysis of 103 cases - in two volumes

Abstract

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 was openedAs 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 seq.)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 jejunum (p.19).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 (p. 77).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 Britlsh Museum.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.