FLEXION OF THE DOUBLE COLON 295 



course, that under peristaltic movements these so-called 

 flexions or bends of the bowel are in constant process of 

 make and unmake. The condition only becomes patho- 

 logical when from some cause or other it becomes per- 

 manent. When the condition becomes permanent, then 

 there is formed at what we may call the elbow of the 

 bend a sort of wrinkling or puckering of the bowel wall. 

 This wrinkling or puckering in turn forms a prominence 

 in the lumen of the bowel (see the point marked +). 

 This prominence alone, apart from any paralysis of the 

 bowel wall, tends to cause stasis of the ingesta, and 

 occlusion. 



Causes. — So far as they relate to flexions of the 



Fig. 27. — Flexion or Bend of the Intestine. 

 A A, Lumen of the bowel ; B, position of the flexion. 



double colon I recognize three main causes — viz., pres- 

 sure on the bowel from without ; local paresis of the 

 wall ; and traction. The best instance of pressure that 

 comes to my mind is the pressing of an over-loaded 

 stomach on the suprasternal and diaphragmatic flexures. 

 This needs some little explanation ; and I recollect one 

 case in particular which will serve to illustrate it. The 

 subject of the case, a heavy cart mare, exhibited during 

 illness all the symptoms associated with subacute ob- 

 structive colic. In spite of treatment she died. At the 

 autopsy there was nothing at all to account for death 

 except this peculiar condition of bending of the bowel — 

 no torsion or twist of any portion of the intestine, and not 



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