REDUCTION OF TWIST OF THE COLON. 591 



latter is distended with food, must not be mistaken for those of the 

 colon. Such an error is avoided by remembering that normally the 

 caecum runs from the outer angle of the right ilium in a bow directed 

 backwards and ends near the left stifle. 



Prognosis. In very exceptional cases torsion may be reduced 

 by the animal rolling, but, as a rule, the only chance of recovery 

 lies in early manual treatment. Though the question whether re- 

 duction is possible in every case, or how often it may be effected, 

 cannot yet be settled for want of published observations, it is clear, 

 from Jelkmanu's communication, that it often succeeds, and Moller 

 considers it practicable though it certainly requires considerable 

 muscular power in the arms and ability to withstand fatigue. This 

 would probably become less after practice. 



Treatment is commenced by giving a clyster of lukewarm water 

 in order to clear the rectum as far as possible, and to obtain sufficient 

 room for introducing the hand. Jelkmann inserts the left hand, 

 presses forward towards the left abdominal wall, and endeavours 

 to thrust the left portion of the colon with the convolutions of the 

 rectum forwards from this point towards the middle line of the 

 abdomen. Once the bowel is brought into this position, Jelkmann 

 passes the hand slowly upwards, when the colon falls back over 

 it into its normal position ; he considers that the convolutions of 

 rectum, displaced towards the left lower abdominal wall, having 

 been thrust upwards, leave room for the colon to return to its normal 

 position. Moller's experiments tend to support this explanation. 



Moller replaced a left rotation of the colon in the following way : — 

 After emptying the rectum, the right hand was introduced, and 

 discovered the bands of the colon running from in front backwards 

 and outwards or towards the left. The bands of the colon lying 

 above were now employed to bring about reposition. Whilst the 

 hand in the rectum was strongly abducted, its volar surface or the 

 fingers were laid against the bands, and after repeated careful attempts 

 finally succeeded in drawing these so far towards the right that the 

 colon again took up its position parallel with the middle line of the 

 body. As had been shown by the experiments on dead animals, 

 in torsion towards the left, the bands of the lower section of the bowel 

 offer a purchase for retroversion. After effecting this, the pelvic 

 flexure of the bowel, until then filled with gas, at once collapsed, 

 the symptoms of colic disappeared, peristaltic action, which had 

 almost completely ceased, again set in, the small, frequent pulse 

 altered its character, and half an hour later the recovery of the 

 animal could be confidently foretold. 



