but it is advisable to do it almoft immediately, i. e. as foon as we can without giving offence to the friends or relations of the deceased, by our betraying too great anxiety to begin our operation, as if we were void of feeling: a certain degree of folemnity is always prudent in these matters. It is well known to anatomifts, that the natural appearance of the different parts of the human body is foon changed after death; and that those parts which had been previously difeafed, fooner fuffer this change than thofe which had not, confequently they foon become very unfit for the investigation of the caufes of difeafes; for, after putrefaction has taken place in any confiderable degree, the appearance of the parts will be fo much altered, as to make it difficult for the most experienced anatomift to fay, what parts had been diseased and what had not: this is of confiderable importance, and ought conftantly to be attended to in our anatomical pursuits. It was the opinion of a very justly celebrated physician and anatomift, Dr. Wm. Hunter, that the most probable means of improving the fcience of phyfic, would be "a more general, and a more accurate examination of diseases after death." The opinion of so great a man as Dr. Hunter, must certainly add great weight to what I have faid; and if we are really defirous of promoting knowledge, it will have its proper effect. Thus, Gentlemen, I have offered you my ideas on a fubject of no small importance; wishing they may meet with your approbation and fupport. Having refolved, myself, to pursue the plan I have pointed out above, I fhall take every opportunity of communicating the refult of my investigations and inquiries to the public; thereby hoping to contribute my mite towards extending our art, as well as to improve myself. I fhall fubjoin two curious cafes, which I had lately an opportunity of examining, together with a drawing to illustrate one of them. I remain, GENTLEMEN, With refpect, Your very humble Servant, Alderfgate-freet. 08. 1, 1799. CASE I. The fubject of this cafe was a child, aged fix months, who, previously to the illness of which he died, was healthy and ftrong. Upon infpecting the body, the attention was arrested by the uncommon uncommon diftention of the epigastric and umbilical regions; the hypogaftric being nearly in its natural ftate. Upon opening the abdomen, no omentum was to be seen; the tranfverfe arch of the colon was likewife miffing; the fmall intestines were extremely diftended with air, and comtained little fœculent matter; they did not appear to have been in the smallest degree inflamed. On the left fide, near the loins, a very hard tumour, about four inches and a half in length, was foon difcovered. Having made a couple of ligatures, one above and the other below the difeafed portion, I removed it, as reprefented in the plate it appeared to be a double intus-fufceptio. A portion of the inteftinum ilium, with the cæcum, its appendix, and the whole of the tranfverfe arch of the colon, had paffed downwards into the figmoid flexure; the cæcum, appendix cæci, with a small portion of the ilium, occupied the lowest part of the colon near its terinination, and formed a firm mafs of a livid colour. A portion of the figmoid flexure was reflected over the tumour for the space of an inch, and had, by the ftricture it occcafioned, ftrangulated it: no adhefions had taken place. Between the fold of the lower intus-fufceptio, a quantity of a yellowish coloured fluid was found. The inteftine, when drawn out, measured, from one liga-ture to the other, more than 22 inches, fo that about fixteen inches of inteftine had paffed from above downwards; and two inches from below upwards, at the lower intus-fufceptio. The information I received refpecting the fymptoms of this cafe was, that the child was firft feized with rigour, which was fucceeded by vomiting, and which continued to the laft. It had likewife one evacuation of pure blood, probably occafioned by the ftrangulation of the lower part of the tumor. It is remarkable, that the child did not appear to fuffer the leaft pain. No medicine, as may be imagined, had the smallest -effect. The child was feized with rigour on Sunday the first of September, and died on the Wednesday morning following ;— and was opened the next morning. From confidering the nature of this difcafe, and particularly from its fituation being near the rectum, which must have been known, from the impoffibility of throwing more than a very fmall quantity into the rectum, which was actually the cafe, the clyfters being conftantly returned without paffing; does it not fuggeft the idea to us of making ufe of mechanical means, by the ufe of a large bougie introduced into the rectum? Would fuch practice be attended with any probability of fuccefs? or, would it be prudent to attempt it? Thefe are queftions which I fhall I fhall leave to be decided by men of fuperior abilities to my own; we are certain that death muft be the confequence, if this disease is left to itself, and that speedily; are we not, on that account, authorised to try every means in our power, provided there is the fmalleft chance of fuccefs? CASE II. The fubject of this cafe was a child aged twenty-two months. The whole body was emaciated to the greateft degree poffible, with anafarcous extremities. Upon opening the thorax, the lungs on the right fide adhered to the pleura, lining the cavity of the thorax; but no mark of disease was perceived in the lungs themselves. The pericardium was diftended; and, upon opening it, a very large quantity of a reddifh coloured fluid flowed out; the heart itself was found, but completely immersed in fluid. In the abdomen, the liver was larger than ufual, fomewhat difcoloured, and the left lobe was much indurated: nothing particular was perceived in the gall bladder and billiary ducts; the ftomach was very large, and contained fome indigestible matter; the inteftines appeared in their natural state: the mefentery fhewed more evident marks of disease, being every where full of obftructed glands, many large, being of the fize of a walnut, and in fome places they formed clusters; the fpleen, pancreas, and remainder of the abdominal vifcera were to appearance found. This child, for fix months after its birth, was to all appearance very healthy; about this time a purging came on, of a greenifh, foetid matter, which continued with greater or lefs "violence till its death. The child gradually wafted away, without any other fymptom of disease befides the diarrhoea; at firft a vomiting attended the purging, but this, after a time, ceased. She did not appear to fuffer any particular pain, but was always languid; her appetite was frequently voracious. She had fometimes a cough, and, towards the last, her breathing was very quick; fhe was reftlefs, and would fcream violently when the awoke from her fleep. Some little time before her death fhe became quite anafarcous; her extremities. were diftended to fuch a degree as to threaten gangrene, the fkin being tenfe, thining, and difcoloured. From the uniformity of the fymptoms of this disease, for so great a length of time, no journal was kept of them, particularly as no medicines were exhibited, except at the beginning of the difeafe, when the purging 'came on. EXPLANA |