VOL. LXXVI.] PHILOSOPHICAL TRANSACTIONS. IIQ 



Xy* History and Dissection of an Extraordinary Tiitrosusception. By John 

 Coakley Lettsom, M. D. F. R. S. and A. S. p. 305. 



A. B. a child 4 years old, was first indisposed about the middle of Sept. 1784. 

 When I was consulted, says Dr. L., which was on the 7 th of Oct. the symptoms 

 resembled those of a cholera morbus. At this period however the diarrhoea had 

 ceased ; but the patient continued frequently to vomit, especially after taking 

 nourishment. On the 20th a dysentery succeeded, with mucous and bloody 

 stools, which ceased after a few days continuance, when she nearly recovered her 

 former state of health, without even reaching after her usual food. She was now 

 removed into the country ; and I did not hear of her again till Dec. when she was 

 brought to town, on account of the return of the dysentery, which was then ac- 

 companied with a troublesome tenesmus, and a considerable degree of fever. 



By anodyne medicines, and the use of opiate clysters, these complaints were 

 occasionally moderated, and sometimes they totally ceased for a few days, but 

 seldom longer, and the intervals of relief gradually shortened ; the attacks be- 

 came also more violent, commencing with violent rigors, and fever succeeding ; 

 the pulse got weaker and weaker, and the patient became extremely extenuated 

 in flesh ; and towards the conclusion of this month, after repeated vomitings of a 

 dark-coloured fluid, like coffee grounds, it finished its painful existence. Bleed- 

 ing, before the debility was become alarming, afforded no material respite. Fo- 

 mentations to the abdomen, and tepid bathing of the whole body, were equally in- 

 effectual. Anodyne starch clysters afforded some truce, but it could not be 

 durable ; the nature of the mischief was too momentous to afford any hope of 

 permanent relief, as the dissection after death will evince. 



Examination of the Body after Deaths by Mr. Thos. Whately, Surgeon. — On 

 exposing the cavity of the abdomen, the sigmoid flexure of the colon immediately 

 presented itself to view, enlarged to the size of that of an adult, as also a large 

 distended intestine appearing to be at first view a continuation of the transverse 

 arch of this gut ; and at the place where this seeming arch joined the sigmoid 

 flexure, there appeared a firm or tight band, as if surrounding the intestine, and 

 here it was strongly bound down. On a nicer inspection this arch was found to 

 be a portion of the ileum, which passing within the band was inclosed in the 

 sigmoid flexure of the colon. All the parts between this portion of the small in- 

 testines and the sigmoid flexure, among which were the caput coli, the cascum 

 with its appendix, and the whole of the great arch of the colon, could no where 

 be seen. The want of these parts, with the enlarged size of the sigmoid flexure 

 and the hard feel evidently showing that it contained some substance, left no room 

 to doubt, but that all the missing portion of the intestines was contained within 

 the sigmoid flexure. A finger introduced into the anus felt a round substance in 

 the rectum, with an opening in the middle, not unlike the os tincae. This sub- 



