The Wilmingtonian., 1885-12-05
The Medical Recor

FEW questions present more interest for
the surgeon than those referring to the dag
nosis and treatment of acute intestinal
obstruction. 1t is fair to presume then that
their discussion iu the papers of Drs. Sands
y. Il. post, will command a widespread
attention. To such as may study the cases
presented and the remarks thereon, it muht
be quite apparent that the difficulties in the
way of making an accurate diagnosis in anv
given case of acute intestinal obstuction
| are very great indeed, and even when the
nature Of the lesion is made out, the line
of treatment is, in the generality of cases at
| least, by no means settled. There are,
indeed, SO many conditions to be taken into
| account before diagnosis can be arrived at
and such an Inconsistency in what may be
| considered the characteristic symptoms of a
given lesion producing obstruction, that it is
hardly surprising that almost every case is
\ involved i'll more or less obscurity. This
fact is strikingly manifested in the case
reported by DIR. Sands, and which forms the
basis Of his paper, Notwithstanding Tho
most careful study of all the symptoms, the
most thorough appreciation of their indi-
vidual and collective bearing upon the pro-
bable cause of the obstruction, the patient
died without diagnosis being made as to
the character or seat of the difficulty.
Unfortunately, similar cases are quite too
iSSm Ilail ~ ~ mu - aa.sg sgsn,sr. ,faE {
4 P5s.c'Vc c.aSnos IN any given Instance.
| Inasmuch as the question of treatment
| depends upon the accuracy with which the
cause and seat of the obstruction are deter
mined, the discussion Of the expediency oi
laparotomy for that reason alone, is mar
rowed to very small limits. But this is moi
all. Laparotomy is formidable operation
1t is last chance for the patient, and ver1
slim one at that. Para6oxical as it MAY
seem, the cases which, on general princi
PIES demand it the most urgently-for il
stance, those in which the attack is sudden
and severe and the grave symptoms rapidly
progressive, are most likely to die if the op
GRAFTON is performed. On the other hand
the cases of slower progress but in which
the prognosis would appear to be equally
grave, not iufrequently recover if let alone
Even when there is every reason to believe
that the obstruction is due to nterna
strangulatiOn, the latter sometimes free
itself in very remarkable and unexpected
manner, and the patient is restored tC
health. Taking into account the dificultie,
Of making positive diagnosis in given
case, and even in particular instance o
finding and relieving the obstruction when
laparotomy is performed, and offsettlng
these against not unreasonable chance o
the patient finally recovering without any
operation whatever, there is no great likeli
hood that laparotomy will be very popular
procedure. Indeed, until we can sufficiently
perfect our means of diagnosis to deter.
mine the seat and character of the obstruc
ton, aud be able to decide early, with reas-
enable positiveness, that the obstruction
cannot be overcome short of an operation
then it would appear to be the duty of the
surgeon to advise laparotomy. But that VIZ
are far from being certain on any of these
points is made very apparent by the rather
exhaustive discussion of the subie in the
| DrpSput issue