» TORSION OF THE DOUBLE COLON 293 



certain amount of ballooning of the rectum, rendering 

 manipulation less difficult. It is a point of practical 

 importance, too, to remember that reduction is far easier 

 if the case is allowed to go for a few hours before mani- 

 pulation is attempted. The more violent of the expul- 

 sive efforts of the patient have then subsided, the inserted 

 arm is not nearly so soon affected with cramp, and there 

 is far less risk of inflicting injury on the interposed rectal 

 walls. 



If attention be paid to these points, and, above all, to 

 a close consideration of the regional anatomy, then one 

 can certainly promise the operator much in the way of 

 results that will fill him with gratified astonishment. 



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