218 PHILOSOPHICAL TRANSACTIONS. [aNNO 1/77. 



he had several times felt, must have put an end to his life. He had an idea that 

 there might be a collection of matter behind the sternum, which might be dis- 

 charged by some chirurgical operation. On examining the part, which with 

 the whole body was very much emaciated, there was no protrusion or discolora- 

 tion. All thoughts of making any perforation were laid aside; and it was 

 thought probable, tliat there was some inflammation or adhesion of the pericar- 

 dium, or of the heart itself, at its anterior part, just above the diaphragm. 

 His cough was almost incessant in the night since he had left off the use of 

 opium, to which he had been long accustomed. For 7 or 8 years, he said, he 

 believed he might have had '20 purging stools in every '24 hours, from a com- 

 plaint in his bowels, the principal seat of which he pointed out so exactly in his 

 emaciated state, that it was observed at the time it must be in the colon, where 

 it passes down on the outside of the lower end of the left kidney. It was there- 

 fore thought probable that there was contraction with internal ulceration of the 

 gut at that place: and about 3 years before, with this complaint, which always 

 continued in his bowels and left side, he had a fistula in ano, for which he was 

 cut, and so cured of that disorder; but from that time, he was always sensible 

 that the lower part of the rectum remained in an aukward, uneasy state, so that 

 it was difficult and painful to pass a common glister-pipe into it. His medical 

 friends were of opinion, that no more could be done for him than to palliate, 

 and to procure ease and sleep. He returned to his opium, of which he took 

 one grain twice a day; and at times was much relieved and comforted by it. 



The heart and lungs were examined with great care, but there was hardly any 

 appearance of disorder in either, contrary to what was expected. The conjecture 

 that had been formed about the complaint in the bowels proved to be perfectly 

 just. The small intestines were apparently pretty sound; the caecum and 

 beginning of the colon were much distended with air, but not inflamed. The 

 arch, or transverse turn of the colon, was likewise much distended, and its 

 blood-vessels were so loaded, that there was, at first sight, the outward appear- 

 ance of an internal inflammation. The enlarged part of the colon terminated 

 at the lower end of the left kidney, where there was an aniuilar stricture on the 

 outside of the gut, and there the gut felt hard and fleshy. The enlarged part 

 being slit up, was much inflamed and superficially ulcerated on the inside, and 

 more in proportion towards the lower end. At the stricture there was but a very 

 small passage left, winding irregularly through an inch and a half of hard 

 ulcerated gut. Below this, where the colon passes over the psoas and iliac 

 vessels, it was in its natural state; but the rectum had been at some former time 

 very much diseased, and for a finger's length to within '2 inches of the anus was 

 contracted to almost a goose-quill size, and of a livid colour. The lower 2 inches 

 were not so much contracted, but of the same livid colour, and the surface of 



