ON THE COMPARATIVE RARITY OF ENTERITIS 323 



causes the mucous coats to assume any shade of red from 

 pink to bright scarlet, but this cannot he seen through the 

 ■walls of the intestines ; the gut must be laid open before it 

 is revealed. Strangulation, on the other hand, affects the ' 

 colour of all the coats forming the walls of the intestines, 

 and is as marked in the peritoneal as in the mucous tunic. 

 This is an important and distinctive difference, and I am 

 perfectly positive on this point. 



' I distinguish strangulation by the intense depth of 

 colour, red, blue, or black, affecting all the coats of the 

 intestine, the peritoneal and muscular as well as the 

 mucous, and, moreover, by the deep coloration being 

 limited, and generally ending abruptly ; this latter is im- 

 portant. Suppose, for instance, I am examining post 

 mortem a case of twist of the colon at its diaphragmatic 

 flexure. I know that one-half of the colon will be black 

 and gangrenous as far as the diaphragmatic flexure, and 

 that from there to the head of the colon it ivill he quite 

 normal in colour; and, more than this, that when I undo 

 the twist by turning the gut over, a sharp white line will 

 be left as if a string had been drawn tightly around the 

 intestine.' 



Fortunately I am able to illustrate this with a photo- 

 graph I took some few years ago of just such a case of 

 twist as Major-General Smith takes for the point of his 

 remarks (see Fig. 31). 



Almost as faithfully as though executed in colours this 

 shows the intense discoloration of the strangulated 

 second portion of the bowel from its suprasternal flexure 

 backwards. Moreover, a comparison of the discoloured 

 strangulated portion with the comparatively unaltered 

 colour of the first portion of the bowel and the caecum 

 serves to point out how sharply marked in a case of twist 

 is the dividing-line between the gangrenous bowel and 

 that which is healthy. 



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