Harveian lectures on the mode of death from acute intestinal strangulation and chronic intestinal obstruction : delivered before the Harveian Society of London, 1884 / by Thomas Bryant.

Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: Harveian lectures on the mode of death from acute intestinal strangulation and chronic intestinal obstruction : delivered before the Harveian Society of London, 1884 / by Thomas Bryant. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    ploratory abdominal operation is the only scientific surgical proceed- ing, and this should be undertaken as soon as a diagnosis of strangu- lation is made. In the case of a patient suffering with symptoms of sti'angulated bowel, and the subject of an old hernia, the rule of sur- gery is to explore the hernia, and, if nothing should be found in the hernial swelling to explain symptoms, to explore the neck of the her- nial sac or abdominal cavity. In a case of a patient suffering with symptoms of strangulated bowel, but without an actual hernia, I trust a like rule of practice will soon be followed; and that a surgeon, in the future, will at once, on the diagnosis of strangulation being made, explore the abdomen, first to find out the true cause of the strangulation, and, sesondly, to relieve it. In either case, failure will often follow the attempt; but success is likely to attend an early effort, when it will fail to follow a late one. And where success ensues, it means a life has been saved that, under other cir- cumstances, woiild to a certainty have been lost. I am well aware of the objections which may be raised against this advice ; that it may be said that, since the diagnosis of any given case is uncertain, the treatment of it should not be heroic ; and like- wise that, since many cases, which appeared to be hopeless, have re- covered without operation, the surgeon is not justified in submitting his patient to an operative ordeal. I can only answer to the first of these objections, that an operation is only suggested in cases in which symptoms of acute intestinal strangulation, similar to those of an acute external hernia, are present, and that, under such circumstances, an exploratory operation for investigation, as well as for relief, is not only justifiable, but absolutely demanded. In the one case, as in the other, the object of the operation is first to find, and then to remove, the cause of strangulation. With respect to the second objection, I would say that it is well knoAvn that, in cases of strangulated hernia, recovery sometimes takes place without operation ; but that no prudent surgeon, on that account, would use such cases as an argument against operative inter- ference. An operation in a case of strangulated hernia may not be absolutely necessary ; nevertheless it is the surgeon's duty to propose it. With a like object, I hold that, with symptoms of acute intes- tinal strangulation, though recovery may possibly take place by natural processes without operation, there is every probability against such a result being brought about. Under these circumstances, there- fore, I hold that an exploratory operation is not only justifiable, but right. By the general adoption of this practice, I feel convinced that more lives would be saved than by the expectant principle which now too generally predominates. The following brief notes (extracted from my note-book) of cases in which relief could have been afforded by operation support this view. They are taken at random, and are only a few out of many that I could adduce. Case iv.—James H., aged 46, who Jiad been ruptured two years, was admitted in 1869, with symptoms of acute strangulation of two days' standing. The hernia was explored, but nothing was found, and the man died unrelieved on the thirteenth day. After death, a band