DETECTION OF TWIST OF THE COLON. 
331 
quarters been met with distrust, this may be explained in part by the 
fact that practitioners had not made themselves sufficiently acquainted 
with the anatomical conditions or methods of surgical treatment. In 
205 colic patients Jelkmann found displacement 13 times, and effected 
recovery by retroversion. During 1890, 63 cases of rotation of the colon 
were met with in the horses of the Prussian army, and during 1891, 52 
cases. 
Jelkmann says the twist is usually towards the right, and is produced 
by distension of the upper portion of the colon and its displacement 
from the left lower wall of the belly at the same time that portions of 
the rectum are forced towards this spot. If the animals rise aftei lying 
on the right side, the upper portion of the bowel, which has been displaced 
towards the middle line of the belly, is thrust downwards and finally 
twisted around its long axis. This explains many cases; but just the 
opposite sometimes occurs, and twist takes place towards the left, as is 
shown by the reports of post-mortem examinations in the Pathological 
Institute of the Berlin College. Sometimes the upper layer of the colon 
is displaced towards the centre line, sometimes towards the left abdominal 
wall. The comparatively great length of the portion of bowel filled 
with food, and its freedom to move, explain the frequent occurrence 
of rotation. (For the normal position of the abdominal contents see 
figs. 143, 144 & 145.) 
The symptoms are not characteristic, but a rectal examination generally 
removes any doubt. When colic, at first slight, is accompanied by con¬ 
tinued pain and becomes worse hour by hour, the bowel sounds weaker, 
the pulse smaller and more frequent, and some form of stoppage of the 
bowel seems certain, a rectal examination will generally clear up the 
point. In front of the anus, one feels the distended colon, which may 
for the moment be mistaken for the over-filled urinary bladder, but 
careful examination reveals its real nature. The longitudinal muscular 
bands can be distinctly felt, and show, not only that we have to deal with 
the colon, but also in what direction torsion has occurred. When the 
bowel is in its proper position, the bands run nearly parallel with the long 
axis of the body ; but in twists, a change in their course is distinctly 
appreciable. In torsion towards the right, they run backwards and 
inwards ; in torsion towards the left, backwards and outwards. Accoiding 
to Jelkmann, the rectal mesentery, whose fixed border can be felt below 
the lumbar vertebrae, appears greatly stretched, and in right rotation 
does not pass perpendicularly downwards, but towards the left, and 
pressure on it causes the animal pain. Careful examination of the 
direction of the bands of the colon seems of more importance in diagnosis, 
and no doubt can exist either as to the presence or direction of the 
torsion if they can be discovered, but the posterior bands of the caecum, 
