REDUCTION OF TWIST OF THE COLON. 
which can be distinctly felt when the latter is distended with food, must 
not be mistaken for those of the colon. Such an error is avoided by 
remembering that normally the caecum runs from the outer angle of the 
right ilium in a bow directed backwards and ends near the left stifle. 
By removing that portion of the left abdominal wall lying between the last 
rib, the outer angle of the ilium, and the tranverse processes of the lumbar 
vertebrae, whilst the dead subject was supported in an erect posture, Moller 
confirmed the anatomical relations of the organs lying in the posterior section 
of the abdomen and in the pelvis ; the colon can be greatly inflated in situ, or 
after successful rotation, filled with water. The hand introduced into the 
rectum allows of the experiment being easily controlled, and the experimenter 
may convince himself which portion the hand is touching. Carried out before 
students, such a demonstration is exceedingly instructive. 
After artificial rotation the change in position of the organs could be 
recognised, and replacement attempted from the rectum. The experiment 
shows that the position of the bands is very important, especially as torsion 
of the posterior sections of the colon displaces the attached border of the 
great and rectal mesentery only very slightly. Examination of the bands left 
no doubt as to the displacement, or the facility with which diagnosis should 
be effected in cases met with in practice. 
Prognosis. In very exceptional cases torsion may be reduced by the 
animal rolling, but, as a rule, the only chance of recovery lies in early 
manual treatment. Though the question whether reduction is possible in 
every case, or how often it may be effected, cannot -yet be settled for 
want of published observations, it is clear, from Jelkmann’s communica¬ 
tion, that it often succeeds, and Moller considers it practicable, though 
it certainly requires considerable muscular power in the arms and ability 
to withstand fatigue. This would probably become less after practice. 
Treatment is commenced by giving a clyster of lukewarm water in order 
to clear the rectum as far as possible, and to obtain sufficient room for 
introducing the hand. Jelkmann inserts the left hand, presses forward 
towards the left abdominal wall, and endeavours to thrust the left 
portion of the colon with the convolutions of the rectum forwards from 
this point towards the middle line of the abdomen. Once the bowel is 
brought into this position, Jelkmann passes the hand slowly upwards, 
when the colon falls back over it into its normal position ; he considers 
that the convolutions of rectum, displaced towards the left lower abdominal 
wall, having been thrust upwards, leave room for the colon to return 
to its normal position. Moller’s experiments tend to support this 
explanation. 
Moller replaced a left rotation of the colon in the following way :_ 
After emptying the rectum, the right hand was introduced, and dis¬ 
covered the bands of the colon running from in front backwards and 
outwards or towards the left. The bands of the colon lying above were 
now employed to bring about reposition. Whilst the hand in the rectum 
