TORSION OF THE DOUBLE COLON 289 



to discount what has been laid down by Jelkmann and 

 Moller. It simply means that I have not been able to 

 diagnose the direction of the twist in this way myself, 

 partly, I think, for the reason I have mentioned before — 

 namely, that my patients are nearly always among the 

 big and unwieldly Lincolnshire Shires. That there was 

 ' something in the operation,' however, was forcibly 

 brought home to me some time ago when treating a 

 nine months' old foal. The case, after going through all 

 the phases of incomplete twist, being taken with what 

 was apparently just ordinary impaction, treated first by 

 the owner and then by myself, lingering on for longer 

 than forty-eight hours, with a gradual exacerbation of the 

 symptoms, and finally commencing to show the usually 

 fatal signs of a failing pulse and pallid mucous mem- 

 branes, accompanied by constant straining attempts at 

 defsecation, suddenly yielded to manual interference. 



The case is particularly stamped on my mind, as it 

 happened to be the first in which I performed a rectal 

 examination with any idea at all of doing something to 

 relieve the trouble. On the occasion of my first visit I 

 detected per rectum the gas-distended pelvic flexure, and 

 the tightened rectal mesentery, conditions so indicative 

 of these cases of incomplete twist. I thereupon pro- 

 ceeded, as I always do, with the administration of 

 stimulants, hoping each time that I afterwards made a 

 visit to find that some alteration in the unfavourable dis- 

 position of the viscera had taken place. That, however, 

 was not to happen. Hour after hour elapsed with the 

 patient growing steadily worse. One expedient after 

 the other was tried, including frequent hot-water enemata, 

 and three doses of eserine and pilocarpine. The owner, 

 only a man in a small way, was growing more and more 

 anxious. I myself, seeing no change at all in the 



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