INTUSSUSCEPTION. 
247 
He remained quite well during the first five days of the voyage/ 
He then began to show signs of illness. He refused food and 
assumed a sullen disposition. There was no movement of the 
bowels and no vomiting. A brother passenger to the patient, 
taking similar diet, was enjoying his customary good health. 
" On the following day the condition of the patient became worse ; 
he groaned loudly and seemed to be in much pain. He then lay 
down upon the deck, the eyes lost their lustre, the lids dropped, and 
he seemed oblivious of all. A low, monotonous whine indicated that 
our patient was still suffering, while the lateral decubitus which he 
had adopted showed that his general condition was serious — for, as 
is well known, an elephant in health rarely, if ever, lies down, and 
he even sleeps standing. 
" As nothing but a little blood-stained mucus was passed per 
rectum, an enema was administered, oiei ricini, O j. Most of this 
was retained, but it gave no result. A second dose of castor oil 
was then given per oram, and was followed by a small fluid motion 
with mucus and a few round worms J to i in. in diameter — probably 
the normal denizens of the bowel. The rectal mucosa was slightly 
prolapsed, no doubt as a result of the excessive straining. A 
rectal examination, ^/te whole arm being introduced^ revealed no 
obstruction. 
" To allay the pain with which the patient seemed now to be 
suffering much, a dose of morphia was given by the bowel : liq. 
morph. hydrochl., drs. x. ; aquam. ad 0 3. Not more than half of this 
was retained. 
" Following this the patient was quieter, but as he seemed to be 
sinking a stimulant was given: spiritus vini gallici, O j. ; 
aquam, ad C ss. He did not rally, however, and death followed 
shortly after. 
^* Post-mortem. — The abdomen was opened by an incision in the 
mid-line. The abdominal wall was extremely tough, and about 
I in. in thickness, although singularly devoid of fat. The intestines 
bulged out from the wound, they were much distended. 
" After removing the main portion an intussusception was found 
a few yards from the anus. It formed a tense cylindrical mass 
about 3 ft. in length and quite a foot in diameter. 
On opening the intussusception the walls of the gut were found 
to be swollen with oedema to a thickness of 2 in. Above the intus- 
susception was a large mass of faeces about the size of a cocoanut. 
This was soft and friable, and, therefore, presumably not the cause 
of the condition. 
In looking back upon the case, the possibility of operating 
occurs to one. But having regard to the difficulty in finding the 
