TORSION OF THE DOUBLE COLON 263 



therein of large swellings, and by brownish and blackish- 

 red discoloration. 



'The intestinal wall, extremely tender, is infiltrated 

 with blood. The contents of the twisted or strangulated 

 portion consist of a reddish-brown pulp, or of blood, 

 brownish in colour. Sometimes the intestinal wall is 

 necrosed, and the mucous membrane shows a blackish 

 green coloration with erosions. 



' Anterior to the constricting band (which band, we 

 may mention, is simply the tightened wall of the bowel 

 itself at the seat of torsion, H. C. R.), the intestinal wall 

 appears thinned, owing to distension, and is deprived of 

 blood. 



' These different changes vary very much, according to 

 the degree of torsion and the length of time it has been 

 in existence.' 



Thus far we have dealt with just the free distribution 

 of the colon itself as a circumstance conducive to dis- 

 placement ; and the sum total of the argument advanced 

 is that the build of the bowel alone renders it peculiarly 

 liable to torsion. 



But what is the actual cause ? The answer to that is, 

 A combination of causes, chief among them being that 

 of disordered muscular action. The long muscular 

 bands, with which we have seen the colon is liberally 

 supplied, must play an important part in determining 

 displacement. That these muscular bands are extremely 

 powerful there can be no doubt. Did we wish for 

 assurance on that head, then we need only to consider 

 the enormous weights of ingesta the bowel is called upon 

 to deal with. Even under normal conditions of health, 

 light feeding and easy digestion, with no demand on the 

 bowel muscle for undue effort, the force exerted by these 

 bands must be great. When labouring under abnormal 



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