The Abdomen 175 



inciding with the origin of the superior mesenteric artery, and 

 which had involved the whole of the intestine extending from the 

 duodenum to the level of the transverse colon. Pecus observed a 

 case, but in this instance the torsion was preceded by a natural 

 or accidental rent in the mesentery, which permitted of the passage 

 of a knuckle of the bowel. Robinson tried many times to produce 

 it artificially, without success, except when it was sutured in posi- 

 tion, and even then the sutures were frequently torn out by the 

 forcible self-reduction of the volvulus. Tietze had similar ex- 

 perience. Kirstein and also Mall proved that the mesentery could 

 be twisted 180 degrees without the circulation of the same being 

 affected. This they did by resecting and reversing portions of 

 the bowel. 



Symptoms and Diagnosis. The same pathologic changes 

 take place, and the same symptoms are in evidence, as occur when 

 the bowel becomes strangulated outside the abdominal wall in 

 strangulated hernia. The disturbance in the circulation is followed 

 by migration of microorganisms and lethal peritonitis. Arrest of 

 intestinal circulation, be it within or without the abdominal wall, 

 may always be dififerentiated from obstruction of the lumen if it 

 is remembered that the symptoms of the latter condition are slow 

 and gradual in appearance, that vomiting comes on in the later 

 stages or not at all, and that unless there be perforation by a 

 foreign body, there will rarely, if ever, be inflammatory effusion into 

 the peritoneal cavity ; whereas in the former, the prostration is great 

 and immediate, there is early and copious vomiting, intense thirst, 

 rapid pulse, and bloody effusion into the peritoneal cavity. 



Intussusception. Little is known of the causes of this condi- 

 tion. It is generally attributed to irregular innervation of the 

 muscular coat. In Nothnagel's experiments it was observed to 

 occur normally in some animals like the rabbit. He also found that 

 when an electric current was carried to a point in the bowel it not 

 only caused a contraction of that spot, but also a dilation below it. 

 The bowel below the point of contact gradually worked itself over 

 the contracted portion, and thus produced an intussusception. 

 Senn's experiments render it conceivable that if this condition 

 occurs more often than is suspected spontaneous reduction may also 

 take place in a short time. In many artificial invaginations made 

 by him the intussusception disappeared of its own accord. In 



