TORSION OF THE DOUBLE COLON 285 



nosis is difficult, and skill therein only to be attained by 

 repeated failures and careful checking of the data obtained 

 at post-mortems ; (2) that the operation is one of some 

 magnitude, necessitating not only a very clear understand- 

 ing of the various conditions to be dealt with, but also a 

 large amount of manual dexterity and strength ; (3) that 

 it is somewhat likely to be fought shy of for the reason 

 that it suggests to the uninitiated onlooker an 'aimless 

 groping in the dirt ' — the more so when such groping 

 ends, as it oftentimes must, in failure. But before the 

 operation the surgeon will, if he is tactful, imbue the on- 

 looker with a little of his own enthusiasm by means of a 

 few brief but well-chosen explanations, and give him an 

 intelligent interest in what is going forward. At any 

 rate, as I have remarked on an earlier page of this book, 

 the surgeon should not neglect to undertake any procedure 

 which is calculated to benefit his patient. 



That there are difficulties in the way of the operation 

 I admit in the foregoing paragraph. I must further 

 admit, after several years' experience of these cases of 

 incomplete colic torsion, that it is only during the last 

 few years that I have come myself to see how many of 

 these difficulties may in course of time be surmounted. 

 In other words, although I have had many failures, I 

 have on several occasions, while attempting this manual 

 reduction as described by Jelkmann and MoUer, met with 

 success. Moreover, what success I have had has been 

 more than sufficient to prove to me the correctness of 

 the observations of these authors, and the value of the 

 directions as summed up by MoUer. These latter, 

 therefore, I shall quote here. 



'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 inserting the 



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