On strictures of the intestine : with remarks upon statistics as a guide to diagnosis and treatment / by Sidney Coupland and Henry Morris.

  • Coupland, Sidney, 1849-1930.
Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: On strictures of the intestine : with remarks upon statistics as a guide to diagnosis and treatment / by Sidney Coupland and Henry Morris. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    be summed up in a very few words. We must confess, with Dr. Fagge, that so far as regards the methods employed for the accurate diagnosis of the seat of a stricture of the intestine, it is often impossible to be sure whether the disease is situated in the small or large bowel; and if it be in the large intestine, its precise situation there is extremely difficult to determine. All the rules based upon the symptoms of the disease have been at different times found wanting; and much the some statement may be made in truth with regard to such aids to diagnosis as are afforded by the amount of fluid that may be injected into the canal, by auscultation over various parts of its course during the in- jection and even by the passage of the long tube. In every case where digital examination has proved negative, it might be worth while to adopt the method first practised in this country by Mr. Maunder, largely employed by Professor Simon of Heidelberg, and advocated by Mr. Walsham of St. Bartholomew's Hospital ; that, namely, of the introduction of the whole hand into the rectum. This method was employed in our case (above referred to) of stricture of the sigmoid, but, owing to the folds of the canal, the stricture was not reached ; and it was well that it was not, for at the necropsy subsequently, the bowel at the seat of stricture gave way on the slightest traction. Mr. Walsham also had failed in detecting a stricture of the sigmoid flexure by this means ; so that, valuable as the method may be, it cannot be fully relied on, and, moreover, it should be practised with the greatest caution. But, after all, from what has gone before, it will be seen that, in our opinion, the precise determination of the seat of stricture is not of primary importance. In determining this seat, we are thrown back upon statistics : a knowledge of which will be a valuable guide, and they should be taken into prominent account when forming a diagnosis. We know that three-fourths of the cases of stricture in- volve the rectum and the sigmoid flexure ; and we know that, of the remaining one-fouith, a very small proportion are seated above the ileo-crecal valve. Nor if we have arrived only at so imperfect a dia- gnosis as one based upon mere numerical averages, is our line of treat- ment at all the less secure. For we know, also, that the chief part of the passage to suffer from the effects of stricture of the large bowel is the ctecum ; and we know that, if the ascending colon be opened, in 90 per cent, of these cases the opening will be above the seat of stricture, and will also give relief to the overdistendcd crecum ; whilst, as for the remainder—that is, those cases in which colotomy fails