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, olei 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 ½ to 1 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, the 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 O j. 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
1 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