The diagnosis of chronic intussusception in children: With an Account of There Cases.

'On a particular day the child seemed to have pain in the abdomen and vomited once or twice. During the next few days he occasionally vomited, generally in association with a colicky pain. The vomiting has become less frequent, only once in two or three days, and the pain is only occasional. The bowels, which before were open daily, have since the onset been less regular, aperients have been necessary, but when given have worked well and the stools have been normal; there has been no blood in the stool or at most there has only been a streak once or twice, such as might be seen on the stool of any constipated child. The symptom which has troubled the parents most is the wasting; the child after three or four weeks of these vague troubles is obviously getting thin. The temperature throughout has been normal. Such is the history, and with a duration of some weeks even the finding of a more or less dJefinite lump in the abdomen may hardly raise a sujspicion of intussusception, especially when the mother's chief complaint is the wasting. Nevertheless, it is by the detection of the more or less sausage-shaped tumour, and especially by its varying consistency from moment to moment during palpation, that the diagnosis is to be made; to the tactus eruditus also the unnatural emptiness of the right i!iac fossa (Dance's sign) may be useful confirmatory evidence, as in the ordinary acute intussusception.' The purpose of this paper is to describe three cases, which, though conforming to Still's description in some respects, were not diagnosed for a long time, owing to the apparent absence of an abdominal tumour in two of the cases. Previous case reports are given in an appendix.