120 PHILOSOPHICAL TBANSACTIONS. [aNNO 1786. 



stance did not adhere, the finger passing round it freely, between it and the in- 

 ternal coat of the rectum. The liver, the urinary bladder, and small intestines, 

 were the remaining parts which first appeared when the parietes of the abdomen 

 were turned back. 



Upon looking for the omentum, a portion of it only was found, attached to 

 the stomach, the remaining part evidently passed within the band into the sig- 

 moid flexure. The stomach was tied much closer to the spine than natural, by 

 the displacing of the omentum and great arch of the colon. The gall bladder was 

 as large as that of an adult, and was full of thin bile, but without obstruction to 

 its passage mto the duodenum. The general external appearance of all the in- 

 testines was natural, except slight inflammation in some places. The cavity of 

 the abdomen also contained more than half an ounce of thin pus ; and on the 

 right side were two ligamentous peritoneal substances, very much on the stretch; 

 one formed by an extension of that part of the peritoneum called ligament um coli 

 dextrum ; the other at the place where the colon is connected to the peritoneum 

 over the right kidney. 



As the further investigation of this uncommon disease required particular at- 

 tention, I cut out all the parts connected with it, bringing away the whole sig- 

 moid flexure of the colon, with the rectum, anus, uterus, and bladder ; also a 

 part of the arch of the ileum with the omentum, and a portion of the stomach 

 and duodenum. 



I made a longitudinal incision through the coats of the sigmoid flexure of the 

 colon, from the anus to the band at its upper part. Within the cavity, which 

 was lined with mucus, appeared a large intestine, taking on the form of the sig- 

 moid flexure, which on examination proved to be the great arch of the colon and 

 the caecum inverted ; so that the villous coat was external, and in contact with 

 the villous coat of the sigmoid flexure, through the whole extent of both ; at the 

 extremity of which inverted intestine were two apertures, viz. the large one felt 

 by the finger per anum, and a smaller one. It now plainly appeared, that the 

 band was formed by the upper part of the sigmoid flexure being drawn tight by the 

 inversion of the part of the colon immediately above it, the further progress of 

 which was prevented by the peritoneal connections at that place not giving way ; 

 which caused it to appear as a band tying the intestine down. This inclosed in- 

 testine was very much diseased, the upper part next the band being highly in- 

 flamed, and as it approached the caput coli in the rectum gradually terminated in 

 mortification, so that for 3 inches from its extremity it was perfectly black. No 

 adhesion whatever appeared between the coats of these intestines, as this inverted 

 colon might be lifted out of the sigmoid flexure to the band. 



On cutting through the coats of this inverted intestine, it was observed that 

 they were very much thickened and diseased ; the enlargement of the gut, which 



