Although improvements in therapy have resulted in a decided reduction in mortality in simple mechanical obstruction of the small bowel, the mortality in strangulation obstruction is still high. In a recentreport by McKittrick and Sarris,1 59 per cent of the deaths in their patients with intestinal obstruction occurred in the strangulation group. In the hospitals of the Medical College of Virginia, strangulation of the small bowel has been responsible for more deaths in the years 1941 to 1946 than appendicitis with rupture and peritonitis. Most authors agree that the most important factor influencing a favorable outcome in strangulation of the small bowel is early surgical intervention. A study of the patients seen by us during the past five years has impressed us with the likelihood that if close attention is paid to the clinical history and to the physical observations early and correct diagnosis of intestinal strangulation is usually