Course. Diagnosis. 435 



general, either intense symptoms of restlessness occur at once 

 or they increase gradually in intensity. The disease is of short 

 duration, since death occurs rapidly, particularly in displace- 

 ments of the small intestine, sometimes after a few hours, usu- 

 ally towards the end of the first or during the next day. With 

 torsion of the large intestines, particularly with torsion of the 

 small colon, horses may live two or three daj'-s. In other do- 

 mestic animals the course is similar to that in strangulation of 

 the intestines. 



The possibility of spontaneous recovery cannot be excluded 

 a priori ; Init spontaneous reduction may occur only in displace- 

 ments of smaller sections of the intestines and only in the be- 

 ginning of the disease, that is, as long as bloating in the affected 

 portion does not yet exist, which would, of course, make a spon- 

 taneous recovery impossible. 



Diagnosis. Torsion and volvulus can only be diagnosti- 

 cated beyond doubt if rectal examination in large animals, or 

 abdominal palpation in smaller ones, reveals the place of twist- 

 ing or entanglement. The other signs, such as a spiral course 

 of the longitudinal bands of the colon, changes in the interrela- 

 tions of the left divisions of the colon, and their displacement 

 into other portions of the abdominal cavity has no great diag- 

 nostic value, since this is also found in other colicky affections. 

 If, however, the left upper division of the colon of a horse is 

 found along its whole palpable length, obliquel}^ below and to 

 the left of the lower division, then the existence of torsion of 

 the colon is very probable. 



As already mentioned (see page 433), Jelkmann believes that the 

 presence of a tense, tender string running obliquely from above down- 

 ward and to the left in the plane of the fourth dorsal vertebra, and of 

 another tense string in the region of the left flank, is very characteristic. 

 Moller considers the spiral course of the longitudinal bands as decisive. 

 Forssell, on the other hand, thinks that the relation of the left divisions 

 of the colon and the course of the band is the determining diagnostic fac- 

 tor. It must, however, be pointed out that the longitudinal bands of the 

 left lower division may show the same course in every case of bloating 

 or in excessive filling of the colon, because the much-dilated lower di- 

 visions will rise up to the left kidney, the upper division is, at the same 

 time, displaced to the right or to the left, and in conseciuence of an 

 increase in length, these divisions, and also the pelvic flexure, become 

 displaced to the right or left and towards the thorax, which compels the 

 stretched longitudinal bands to assume a spiral course without, however, 

 encroaching upon the intestinal lumen or without the production of a 

 venous congestion. This is proven by the observations of the authors 

 and by those of other authors (Larsen, Klett, Behrens), who also believe 

 that torsion of the colon can, as a rule, not be diagnosticated with cer- 

 tainty by a rectal examination alone. 



The direction of the torsion is determined by IMoller from the course 

 of the longitudinal bands. In torsion to the right, the band of the lower 

 divisions lead from in front towards the back and to the right ; in torsion 

 to the left in the opposite direction. Forssell gives the following rules; 



