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Mr. Copland Hutchinson* attempted, by means of a scalpel and trocar, to open the intestine of a child to all external appearances similarly malformed to the one already alluded to, but was not successful in accomplishing the object, probably owing to the absence of the rectum. Some hæmorrhage took place, which was restrained by application of lint saturated with turpentine. In another instance of a male child with the anus natural, but occluded half an inch from the surface, Mr. Copland Hutchinson endeavoured to establish an opening in the bowel, by thrusting a trocar for more than three inches in depth without success. The child died a few hours after the operation; and a post-mortem examination revealed the intestine separated from the anal cul-de-sac by a quarter of an inch. The trocar had passed behind the intestine, and grazed its walls.

A female child, born the day previously, was brought to Mr. Meymott† there existed no opening into the bowel. A depression existed just at the point of the coccyx, but there was no opening in the skin; the vagina was also occluded: a probe could be passed into an aperture corresponding to the meatus urinarius, but no urine was observed to pass. An incision was made into the perineum to the depth of * Op. cit., pp. 264-274.

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two inches, and the bowel reached, which was made evident by the free escape of meconium. Castor oil, calomel, &c., were administered to the child: it died seventy-six hours after birth. No examination was made.

Mr. D. O. Edwards records the following: a male child born twenty hours previously, had had nothing pass per anum, and refused the breast; its abdomen was distended and painful on pressure; the lower limbs were rigidly contracted on the pelvis; respiration was difficult, and the child constantly moaned. The anus was perfectly formed; the introduction of the finger detected an obstruction an inch from the surface. Forty-eight hours after birth this was incised with a bistoury, but the bowel was not penetrated; the bladder and blood-vessels were felt by the finger introduced into the wound: the child died the following day. An examination was made: the rectum terminated in a cul-de-sac at the middle of the

sacrum, having a meso-rectum in its

and a complete peritoneal, covering.

whole length,

The space of

half an inch intervened between the termination of the rectum and anal cul-de-sac.

Mr. Lindsay, in December, 1829, had brought to him a boy eight months old, born with an imper*Lancet,' vol. i., 1829-30, p. 637.

† Ibid., vol. i., 1835-6, p. 361.

forate anus, and absence of a portion of the rectum. An opening had been made, but at the time he saw him it was nearly closed: by bougies, &c., the aperture was enlarged, and the child grew and became perfectly healthy, but could not retain his fæces. When between five and six years of age he lost flesh, and became very ill it was found the artificial opening had closed so much that a quill could not be passed. Mr. Lindsay conceiving the artificial anus was too near the coccyx, made another more anteriorly: ultimately the posterior opening was closed, and the child had perfect control over the bowel.

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Mr. Smith, of Plymouth,* had a female infant brought to him 17th January, 1840, thirty hours after its birth, in consequence of there having been no evacuation per anum. The anus was perfect, and admitted the finger to be passed up half an inch. Vomiting of a brownish feculent matter had taken place, and this recurred at intervals till the child died. It lived nine days. An examination after death revealed the colon, nine inches in length, terminating in a closed extremity at its transverse portion. A tortuous prolongation from the anus, ten inches in length, and about the size of a swan-quill, extended up the left side of the spine: it was isolated from the other portion of the intestinal canal. He Lancet,' vol. i., 1839-40, p. 794.

also mentions another case of a female infant with imperforate rectum which came under his observation. A dense cellular tissue, three quarters of an inch in thickness, separated the bowel from the anus. An attempt to relieve the child by operation was unsuccessful, and it died on the fifth day from its birth.

Mr. Gosse operated on a child four days old, born with imperforate rectum. The incision was carried more than two inches in depth before the intestine. was reached. The child lived till the twenty-fourth day, when it sank without any particular symptom.

Mr. George attended a lady who gave birth, on the 10th May, 1849, to a child in whom, when two days old, the rectum was discovered to be imperforate. The finger could be introduced up the anus for an inch. Sir Benjamin Brodie saw the case, and decided that an operation would be unadvisable. The child lived five weeks. After death, the terminal portion of the colon was found covered by peritoneum.

Dr. N. Cheverst operated on a male child, five days old, born with imperforate anus, and partial absence of the rectum: the instrument used was a hydrocele trocar, which was passed into the bowel, but the canula proved too small to permit of the escape of the

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* Medical Gazette,' vol. vi., 1848, pp. 16-17.

† Ibid., vol. ix., 1849, p. 280.

Indian Annals of Medicine,' No. 1, p. 296.

intestinal contents; the child died, and the body was thrown into the river by the parents.

Dr. Parker, of New York, records ten cases of imperforation and partial absence of the rectum. In three casesthere was no anal opening; of these, the operation was successful in saving the lives of two of the children. In each of the remaining seven cases the anus was perfect, and a cul-de-sac extended upwards, to a greater or less extent; of these seven children the lives of two were saved; three died within twentyfour hours after the operation; one died on the seventh day from neglect, and the remaining one died in the seventh week from contraction and closure of the artificial opening.

I imagine few English surgeons would propose to adopt the operation of Littre or Callisen for opening the descending colon, much less putting into practice that of Dubois, of opening the sigmoid flexure of the colon, and passing a strong probe through it towards the perineum, by pressure rendering the end prominent, if possible, and then cutting down upon it. So formidable an operation upon a new-born infant could scarcely be otherwise than fatal. But though the surgeon may not be justified in proposing to open the colon from the groin, he may be compelled to

* New York Journal of Medicine,' New Series, vol. xiii., p. 319.

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