A Remarkable Case of Cohesions of All the Intestines, &c. in a Man of about Thirty-Four Years of Age, Who Died Some Time Last Summer, and Afterwards Fell under the Inspection of Mr. Nicholas Jenty

and white. She is still alive, and ready to attest the truth of this narrative. Kidderminster, Sept. 11th, 1757. J. Johnstone. LXXII. A remarkable Case of Cohesions of all the Intestines, &c. in a Man of about Thirty-four Years of Age, who died some time last Summer, and afterwards fell under the Inspection of Mr. Nicholas Jenty. Read Feb. 9, 1758. The subject was tall, and partly emaciated. I found nothing externally but a wound in the left side, which seemed to me to have been degenerated into an ulcer. As I did not know the man when he was alive, and had him two days after his decease, I cannot give an immediate account of the cause of his death. But in opening his abdomen, I found the epiploon adhering close to the intestines, in such a manner, that I could not part it without tearing it. It felt rough and dry. And as I was going to remove the intestines, to examine the mesentery, I found them so coherent one with the other, that it was impossible for me to divide them without laceration. Then I inflated the intestinal tube, for the inspection of this extraordinary phenomenon; but, to my great surprize, all the external parts of the intestines appeared smooth; very few of the circumvolutions were seen, occasioned by the strong lateral cohesions of their sides with with each other! The substance of the intestines was rough, and a great many pimples, as big as the head of a pin, appeared in them, and were almost free from any moisture. It is proper to observe, that these pimples have been taken for glands by the late Dr. James Douglas, and others; whereas they are in reality nothing else but the orifices of the exhaling vessels obstructed, and are not to be met with except in morbid cases. After having made incisions in that part of the colon next to the rectum, I found the peritoneum, or external membrane which invests the intestines, and the viscera of the abdomen, to be of the thickness of a six-pence; and I fairly drew all the intestines from their external membrane without separating their cohesions; the peritoneum, or external membrane, afterwards appearing like another set of intestines. I found a fluid in the intestines; and I will not take upon me to say, how the peristaltic motion must have been performed. And afterwards I parted the stomach from its external tunic, as I had done the intestines. I found no obstruction in the mesenteric glands; but every evolution of the mesentery firmly cohered together. The liver also adhered closely to the diaphragm, and its adjacent parts: and in the vesicula fellea I found the bile pretty thick, neither too green nor too yellow, but a tint between both. I met with nothing remarkable in the other parts of the abdomen. In opening the thorax, I found the lungs closely adhering to the ribs laterally, and posteriorly and interiorly close to the pericardium. In making an incision to open the pericardium, I found it so closely adhering to the heart, that I could not avoid avoid wounding that organ, and with much difficulty could part it from it. I met with no fluid in the pericardium. The heart was small; and in the internal side the pores of the pericardium appeared so large, that one might have infinuated the head of a middling pin into them. They have been described by some anatomists, who have met with cases somewhat similar to this, but without such universal adhesions; and they have been supposed to have been glands. The same pores likewise appeared on the heart; which, in my opinion, are nothing but the extremities of the exhaling vessels. In removing the heart, I found the dorsal, and other lymphatic glands above the lungs, quite large, indurated, and of a dark greyish colour. Nothing remarkable appeared in the lungs; only, that the portion of the pleura, which invests the lungs, and is generally thin, was here thick and rough; and thro' a glass it appeared as if covered with grains of sand; and might in several places have been easily torn from the lungs. The aorta was pretty large; and in that part of it, which runs on the tenth dorsal vertebra, I found a cystis, as big as an olive, full of pus; and lower down, immediately before that vessel perforates the diaphragm, I found another, something less, full of matter likewise; both which portions I have by me. That portion of the aorta, where the cystis appeared, was rather thicker than the other, and osseous. In opening the cranium, I found in that part of the cerebrum, which lies over the cerebellum, a table spoon-full of pus, of a greenish colour; and examining it thro' a glass, there was an appearance of animalcula in it. LXXIII.