no COLICS AND THEIR TREATMENT 



bands. For example, the common torsion of the left 

 colons is to the right; the bands are twisted spirally to- 

 ward the left in this condition. Besides the findings of 

 the rectal examination in cases of torsion, it will be noted 

 that the general condition of the patient is rapidly be- 

 coming serious. This is usually indicated in one to two 

 hours by the change in pulse, peristalsis, temperature 

 and the conjunctiva. There is further profuse sweating, 

 great prostration, collapse, etc. 



If the torsion is not soon removed death will result in 

 six to twelve hours. 



Displacement of the Small Bowels — Volvulus. — 

 Usually a primary impaction of a part of the bowel be- 

 hind the volvulus is the cause of change in position. The 

 primary impaction may be either in the small or in the 

 large bowel. Volvulus of the jejunum is commonly pro- 

 duced by impaction of the ilium at or near its cecal ter- 

 mination. As in the case of the large bowels, a violent 

 anti-peristaltic movement of the bowel lying in front of 

 the impaction favors torsion. 



Contrary to the torsion of the large bowel, volvulus 

 can not be determined positively per rectum. A diag- 

 nosis, therefore, is only possible by way of exclusion, 

 and it is always a probable one. If on rectal exploration 

 no change can be found in the layers of the large intes- 

 tine and the condition of the patient is rapidly growing 

 bad, the probability of the volvulus is great. In some 

 cases a secondary bloating of the small intestine, which 

 may be determined per rectum, points to volvulus. 



Volvulus of the small intestines is nearly always fatal, 

 leading to death in eight to twelve hours. Treatment as 



