Puncture of the distended bowel has recently been recommended anew by Curschmann,1 von Ziemssen, and others. According to Curschmann, puncture of the intestine is performed in the following way: A long aspirator needle of thin calibre (like that of a Pravaz syringe) provided with a stopcock is thrust into the abdomen over a prominent coil of the intestine. A piece of rubber tubing is then connected with the outer end of the needle; the free end of the latter is inserted into a bottle filled with water, which is turned upside down in a basin likewise filled with water. The stopcock of the aspirating needle is now opened and the gas escaping from the intestinal coil appears in bubbles rising to the upper part of the bottle, displacing the water. There is no doubt that considerable temporary relief can be afforded by this mode of procedure, as it lessens the feeling of tension. Occasionally it may also have a direct curative result. Thus Curschmann reports three cures by this method. Puncture, however, is not entirely free from danger.

In cases in which the intestine is already partly paralyzed, the opening after the withdrawal of the needle may not entirely close and intestinal gases and contents may continue to ooze out and cause peritonitis.

Most surgeons of note are against this procedure, as it lacks precision and is not free from danger. Thus Treves,2 Kocher,3 and Graser4 are all opposed to its employment.

1 Curschmann Deutsche med. Wochenschrift, 1887, No. 21. 2 Treves: "Intestinal Obstruction, " New York, 1899,p. 471. 3Kocher: "Mittheilungen aus den Grenzgebieten der Medizin," 1898, Bd. 4, p. 2. 4Graser; Penzoldt-Stinzing's "Handbuch, " Bd. 4, p. 562.

Sad experiences with puncture have been reported by Frentzel,1 Furbringer,2 Hoffmann, Korte,3 and Graser. The latter observed the appearance of fecal matter and consecutive peritonitis from such an opening. He considers puncture permissible only if the patient absolutely refuses an operation.

Mercury (Mercurius Vivus). The internal administration of pure mercury in tablespoonful doses was highly esteemed as a remedy for ileus by the old physicians. When all resources had been exhausted without success, mercury was given as an ultimum refugium. Even nowadays many physicians are convinced of its efficacy. The use of mercury in incarceration, strangulation of the bowel by twists or bands, intussusception, is not permissible, as it does real harm. In ileus in consequence of coprostasis or in dynamic ileus, mercury may be employed if all other remedies have proven futile. Its effect consists in the penetration of the mercury into the accumulated fecal matter, thus softening it.

All the enumerated internal methods of treatment must be applied, first, in cases in which the obstruction is due either to gall stones or to foreign bodies or fecal accumulation or volvulus of the sigmoid flexure; secondly, in cases in which the exact diagnosis as to the kind of obstruction is not settled, and which are not of a very severe type. In all other varieties of intestinal obstruction and even in the types just mentioned, after the failure of the medicinal measures at hand, an operation should be resorted to.

1 Frentzel: Deutsche Zeitschr. f Chirurgie, Bd. 33. 2 Furbringer: Verhandl. des 8ten Congresses f. innere Medicin, 1889. 3 Korte: Ibidem.