I N T 



tents. The difeafe, when it thus begins at the termiftation 

 of the fmallinteftines in the large, is particularly apt to pro- 

 ceed to a confiderable extent, and inoftly proves fatal. 

 Many inftances of this kind are upon record. In the Edin- 

 burgh Medical and Surgical Journal, vol. iii. p. 263, Mr. 

 Langftaff has publifhcd an interelling example. The cafe is 

 that of a child three months old, where, upon examinaticn 

 after death, there was an extcnfive introfufception in the ufual 

 direftioji, together with a fmaller one of the retrograde 

 defcription, fimilar to what occurred in the inllance related 

 by Mr. Spry in the Med. and Phyfical .Journal, No. 11. 



Retrograde introfufceptions are mucli lefs common than 

 fuch as are named progroffive. In the Medical and Chirur- 

 gical Tranfaclions, vol. i. Mr. Home has infertcd the ac- 

 count of a retrograde introfufception, which happened in a 

 cabin boy, who had previoufly fwallowed arfcnic. The 

 cafe was alfo rendered remarkable by a fmall worm, which 

 was found coiled up round the introfufccpted portion of 

 the intcftines. 



A prolapfus ani is, in fome rcfpcfts, fimilar to an introfuf- 

 ception, and may pofli'..ly begin in the fame way ; but it is 

 always continued by the aftion of the abdominal mufcles, 

 and never by that cf the bowel itfelf. It differs from an in- 

 trofufception in not being included in an inteftine ; for in- 

 ftead of having a containing bowel, inverting itfelf by it'= 

 own aftion, there is an incljfcd intefline protruded by the 

 afticn of the abdominal mufcles, while the paffage of the 

 feces through it, and the point of inverfion, are at the ex- 

 tremity of the protrufion ; and as it becomes inverted, it 

 projefts out of the body. Med. and Chir. Tranf. vol. i. 

 p. IT 2. 



With regard to the fymptoms of introfufception, they 

 very much refemble thole attendant on inflammation of the 

 intellines, hernia, and any obli:ruaion in the alimentary 

 canal. In feveral of the cafes upon record, the feat of the 

 difeafe was plainly indicated by a hard timiour upon the left 

 fide of the abdomen. Sometimes it has been found im- 

 polTible to injedl more than a trivial quantity of fluid as a 

 clyfter ; a circumflance which would flrengthen the fufpicion 

 of what the diforder really is. If, alfo, (obferves Mr. 

 Langftaff,) the invaginated portion defcended fo low as to 

 form a protrufion at the anus, and we could afcertain, that 

 it was not an inverfion of the redum itfelf, the cafe might be 

 confidered as clear, and we fhould have no hefitation in de- 

 livering a prognofls, which, by preparing the friends for the 

 fatal termination, would exonerate us from all blame on its 

 occurrence. 



Introfufception, like mofl other difeafes, which are furtheft 

 from the reach of medical and furgical affiftance, has been 

 treated in a great number of different vi-ays. 



Former practitioners very commonly exhibited for its re- 

 lief, a large quantity of crude mercury ; a plan which cer- 

 tainly could never have accomplifhed the defirable objeft of 

 difentangling the affefted part of the bowels. 



It has even been propofcd to perform gaftrotomy, and M. 

 Hevin, in his " Recherches Hilloriques fur la Gallrotomie 

 dans le Cas dn Volvulus," has examined, with nnich ability, 

 the queflion concerning the prudence and propriety of fuch 

 a proceeding. After many intcreding obfervations, he ex- 

 prefTes his decided condemnation of the propofal. The ope- 

 ration, indeed, is rendered quite unwarrantable by the great 

 uncertainty and obfcurity which almoft conftantly prevail 

 in regard to the aclual nature of the cafe ; but even were the 

 exiflence of the difeafe pofitivcly known, the project would 

 not be allowable. In the firft place, cutting into the abdo- 

 men, with a view of difentangling a portion of the bowels, 

 would be of itfelf a fource of the moll dangerous and pro- 



I N V 



bably fatal confeqtiences. And in the fccond place, the 

 fchemeof difentangling the bowels would generally be alto- 

 gether impraclicablc, by reafon of th.s different folds of the 

 intefline having become infeparably agglutinated to each 

 other. This conneftion, in faft, is fo ilrong, that the con- 

 tained parts can hardly be withdrawn after death. In other 

 inflances, the ftrifture on the introfufcepted part caufes it to 

 inflame and even mortify, in either of which ftates gaftrotomy 

 would be quite inadmifiible. 



I'he forcible injeftion of cly tiers was tried by Dr. Monro, 

 without any beneficial efieft. 



Others liave fuggeflcd the introduftion of long bougies 

 and pieces of whalebone vi'ithin the anus, for the purpofe of 

 mechanically pufhing back the introfufcepted portion of the 

 bowels. But after it is known that adhcfions are formed iti 

 the manner already defcribcd, what fuccefs can be expected 

 from any plans of this kind ? And what inftrument could 

 be invented, which would follow the windings of the 

 bowels, a confiderable way . without piercing their coats, 

 and doing the mofh fatal mifchief i 



The manner in which the parts are agglutinated, explains 

 why none of the mctliods hitherto deviled for the relief of an in- 

 trofufception, can be of any material fervice. Were a cafe 

 to be fubmittcd to fome kind of treatment, before adhefiorjs 

 had taken place, perhaps the forcible injeftion of glyfter.i, 

 and theexhibition of vtmits to invert the periftaltic action cf 

 the containing bowel, as propofcd by Mr Hunter, would be 

 as rational flops as any which could be purfued. 



We mud reluftantly acknowledge, however, with Mr. 

 LangflafF, that, in general, a'l the modes of treatment, 

 hitherto propofed, will be found utterly ineiBcient. " Yet 

 here, as in many other inflances, the refources of nature are 

 exhibited in a moll wonderful and aftonifliing manner, while 

 thofe of art completely fail. The invaginated portion of in- 

 tefline fometimes floughs, and is difchar^ed^f,- anum, whila 

 the agglutination of tiie parts preferves the continuity of the 

 inteflmal canal. The annals of medicine furnifh numerous 

 inflances, where long pieces of gut have been difcharged in 

 this manner, and the patient has quite recovered. At the 

 fame time that we recognize the inefftcacy of art, thefe 

 cafes will teach us to repofe a jufl confidence in the powers 

 of nature, and to retain fome hope of a favourable event, 

 under the moll unpromiling circumftances." Lingftaff in 

 Edin. Med. and Surgical Journal, vol iii. p. 267, 268. 



This gentleman has greatly enriched his paper by numerous 

 references which will be deemed exceedingly valuable by any 

 perfon deiirous of being more particularly acquainted with 

 the preceding fubjeft, 



INVADlATtJS, in our Oi'J Wnlers, a perfon accufed 

 cf any crime, which not being fully proved, he was putyiii 

 (kbitajidejuffwr.;, and called invadiatus. 



INVALID, a perfon wounded, maimed, or difabled for 

 aftionbyage. 



.^ t Chelfea and Greenwich are magnificent hofpitals, or ra- 

 ther colleges, built for the reception and accommodation of 

 invalids, or foldiers and feamen worn out in the fervice. See 

 Hospital. 



We have alfo feveral independent companies of invalids, 

 difperfed in the feveral fiorls and garrifons. 



Of thefe the 4ifi: regiment was compofed in 1719, but it 

 has fince been put upon the fame footing with the other regi- 

 ments of the line. In 1782 there were likewife 36 indepen- 

 dent companies, forming the garrifons of Jcrfev, Guernfev, 

 Scilly, Portfmouth, Plymouth, Chefler, Hull, and othi-r 

 forts and callles ; and there were alfo ten independent com- 

 panies of invalids in Ireland. Invalids have been known in 

 this kingdom ever iince the rcfloration of Charles II. The 



invalids 



