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AN ANOMALY OF THE COLON
940
CLINICAL AND
LABORATORY
AN ANOMALY OF THE COLON
BY G. ELLIOT
SMITH, M.D. SYDNEY, F.R.C.P. LOND., F.R.S.
PROFESSOR OF ANATOMY IN THE UNIVERSITY OF LONDON, AT UNIVERSITY COLLEGE
NOTES
dragging on the mesentery, had led to the strangulation of the blood-vessels in the mesentery, causing gangrene of the greater part of the small intestine below the duodeno-jejunal junction, and it had also compressed the blood-vessels supplying the pelvic colon itself, so that it also was in a gangrenous condition. Having lost the original drawing of this condition, perhaps I may reproduce here, for the purpose of elucidating the causation of the gangrene, a drawing of a peculiar anomaly of the colon which was found by two of my students three years afterwards, and published in the Journal of Anatomy and Physiology in 1909. Although in this second case the position of the pelvic colon was quite abnormal, it illustrates how it moved up on the right side of the abdomen to reach the level of the duodeno-jejunal junction. In this drawing I have inserted an arrow to indicate the subsequent course of the displacement which occurred in the fatal case to which I have referred.
THE note by Dr. H. W. Benham on An Unusual Case of Volvulus, in THE LANCET of August 13th, prompts me to put on record another case involving gangrene of most of the small intestine and part of the large intestine which came under my notice in 1905. The case impressed me at the time not only because, so far as I could discover, it was unique, but also because it illustrated the practical importance of anomalies of the colon, of which I saw a number of striking illustrations in the course of my work in Egypt. Hence I prepared a careful report of the case, accompanied by a drawing to make clear the remarkable condition which I found. This was posted to England for publication, and I never heard any more of it. A MODIFICATION OF During the summer of 1905, in the absence of the professor of pathology from Egypt, I was performing BARBERIO’S TEST FOR HUMAN SEMINAL the post-mortems at the Kasr-el-Ainy Hospital. One STAINS evening in the club in Cairo I was struck by the BY G. A. HARRISON, M.D. CAMB. appearance of one of the native Nubian servants who READER IN CHEMICAL PATHOLOGY, UNIVERSITY OF LONDON; seemed to be desperately ill, and I suggested to the CHEMICAL PATHOLOGIST TO ST. BARTHOLOMEW’S HOSPITAL secretary of the club that the man should be sent off. The waiter replied that as he only had another halfhour of duty he would see it through. As originally described Barberio’s test is performed On going to the post-mortem room at the hospital by adding a saturated aqueous or alcoholic solution next morning I saw this man’s corpse on the table, of picric acid to an aqueous extract of the seminal I and found on examination a most remarkable state stain. After a few minutes the mixture is examined microscopically for the crystals which vary in size
(5-20 µ)
and
shape;
these crystals have been described as rhombic needles ; as resembling Charcot-Leyden crystals ; as ovoid or needle-shaped with rounded ends ; as sharp-ended needles ; as rhombic prisms often with a refrangent line at their equator ; as crosses and stars ; or even as small ovoid bodies showing Brownian movement. They are sometimes twinned, and also form drusy
aggregates.145 Rosenheim6 suggested that the crystals were due to spermine picrate. I have shown that this suggestion is correct by performing Barberio’s test on human semen on a relatively large scale, separating
-
the crude picrate and converting it into the hydrochloride and then into the characteristic phosphate.23 At the same time the crystals are probably impure spermine picrate, first because they vary so much in appearance, and secondly because, when the modified test described below is carried out quantitatively on a larger scale, the weight of picrate crystals is several times greater than the theoretical quantity Drawing to illustrate an of picrate corresponding to the final yield of spermine anomaly of the colon. phosphate. It is interesting to note that Barberio found that Poehl’s spermine was the only substance of affairs. He had an excessively long pelvic colon that gave picrate crystals resembling those obtained measuring 83 cm. in length, which was only 1 cm. from human semen. But he observed that after less than the longest recorded case I was able to find heating Poehl’s spermine to 100° F. for one and a at that time. The long loop of pelvic colon had slipped half hours no crystals were obtained with picric up the right side of the abdomen and then fallen to acid, whereas dried semen would stand a temperature the leftover the root of the mesentery. It was of 150°F. (but not of 200°) for one hour and still give a sufficiently long to pass down the left side of the positive reaction. In view of Rosenheim’s observaabdomen into the pelvis. This heavy loop of colon, tion that the commercial material sperminum Poehl
CLINICAL AND
LABORATORY
AN ANOMALY OF THE COLON
BY G. ELLIOT
SMITH, M.D. SYDNEY, F.R.C.P. LOND., F.R.S.
PROFESSOR OF ANATOMY IN THE UNIVERSITY OF LONDON, AT UNIVERSITY COLLEGE
NOTES
dragging on the mesentery, had led to the strangulation of the blood-vessels in the mesentery, causing gangrene of the greater part of the small intestine below the duodeno-jejunal junction, and it had also compressed the blood-vessels supplying the pelvic colon itself, so that it also was in a gangrenous condition. Having lost the original drawing of this condition, perhaps I may reproduce here, for the purpose of elucidating the causation of the gangrene, a drawing of a peculiar anomaly of the colon which was found by two of my students three years afterwards, and published in the Journal of Anatomy and Physiology in 1909. Although in this second case the position of the pelvic colon was quite abnormal, it illustrates how it moved up on the right side of the abdomen to reach the level of the duodeno-jejunal junction. In this drawing I have inserted an arrow to indicate the subsequent course of the displacement which occurred in the fatal case to which I have referred.
THE note by Dr. H. W. Benham on An Unusual Case of Volvulus, in THE LANCET of August 13th, prompts me to put on record another case involving gangrene of most of the small intestine and part of the large intestine which came under my notice in 1905. The case impressed me at the time not only because, so far as I could discover, it was unique, but also because it illustrated the practical importance of anomalies of the colon, of which I saw a number of striking illustrations in the course of my work in Egypt. Hence I prepared a careful report of the case, accompanied by a drawing to make clear the remarkable condition which I found. This was posted to England for publication, and I never heard any more of it. A MODIFICATION OF During the summer of 1905, in the absence of the professor of pathology from Egypt, I was performing BARBERIO’S TEST FOR HUMAN SEMINAL the post-mortems at the Kasr-el-Ainy Hospital. One STAINS evening in the club in Cairo I was struck by the BY G. A. HARRISON, M.D. CAMB. appearance of one of the native Nubian servants who READER IN CHEMICAL PATHOLOGY, UNIVERSITY OF LONDON; seemed to be desperately ill, and I suggested to the CHEMICAL PATHOLOGIST TO ST. BARTHOLOMEW’S HOSPITAL secretary of the club that the man should be sent off. The waiter replied that as he only had another halfhour of duty he would see it through. As originally described Barberio’s test is performed On going to the post-mortem room at the hospital by adding a saturated aqueous or alcoholic solution next morning I saw this man’s corpse on the table, of picric acid to an aqueous extract of the seminal I and found on examination a most remarkable state stain. After a few minutes the mixture is examined microscopically for the crystals which vary in size
(5-20 µ)
and
shape;
these crystals have been described as rhombic needles ; as resembling Charcot-Leyden crystals ; as ovoid or needle-shaped with rounded ends ; as sharp-ended needles ; as rhombic prisms often with a refrangent line at their equator ; as crosses and stars ; or even as small ovoid bodies showing Brownian movement. They are sometimes twinned, and also form drusy
aggregates.145 Rosenheim6 suggested that the crystals were due to spermine picrate. I have shown that this suggestion is correct by performing Barberio’s test on human semen on a relatively large scale, separating
-
the crude picrate and converting it into the hydrochloride and then into the characteristic phosphate.23 At the same time the crystals are probably impure spermine picrate, first because they vary so much in appearance, and secondly because, when the modified test described below is carried out quantitatively on a larger scale, the weight of picrate crystals is several times greater than the theoretical quantity Drawing to illustrate an of picrate corresponding to the final yield of spermine anomaly of the colon. phosphate. It is interesting to note that Barberio found that Poehl’s spermine was the only substance of affairs. He had an excessively long pelvic colon that gave picrate crystals resembling those obtained measuring 83 cm. in length, which was only 1 cm. from human semen. But he observed that after less than the longest recorded case I was able to find heating Poehl’s spermine to 100° F. for one and a at that time. The long loop of pelvic colon had slipped half hours no crystals were obtained with picric up the right side of the abdomen and then fallen to acid, whereas dried semen would stand a temperature the leftover the root of the mesentery. It was of 150°F. (but not of 200°) for one hour and still give a sufficiently long to pass down the left side of the positive reaction. In view of Rosenheim’s observaabdomen into the pelvis. This heavy loop of colon, tion that the commercial material sperminum Poehl