dorsum of the ilium; fluctuation was perceptible, and the parts had a peculiar appearance. After death, the tumour was found to be an abscess, which extended upwards and opened into the canal of the lumbar portion of the spinal column.

Mr. Tatham,* of Huddersfield, operated 16th of January, 1835, on a male child, two days old, for imperforate anus. The urine had been observed to be mixed with the contents of the bowel. The bowel was reached by an incision carried to the depth of one inch from the surface. The child lived till the 20th of March. An examination was made, and the bowel found to communicate with the neck of the bladder by a narrow canal, a quarter of an inch in length.

Dr. York, of South Boston, punctured with a trocar the intestine of a male child born with imperforate anus; the operation was performed when it was three days old. The canula was left in the bowel for a week, after which the opening was dilated by a sponge tent at the end of six weeks the opening was still more increased by incision, and a silver tube threeeighths of an inch in diameter was inserted and retained for a year. The tube becoming corroded when the child was about six months old, fæces were

* 'Lancet,' vol. i., 1835-6, p. 373.

↑ Boston Medical and Surgical Journal,' vol. xlii., p. 273-4.

observed to pass per urethram.

The child died when

eighteen months old, from the effects of a fall: for two months previously, the fæces passed entirely by the urethra, the artificial anus having closed in consequence of the tube being left out.

Dr. Williamson,* of Aberdeen, saw a child, twentyfour hours after birth, in whom there was no indication of an anus, "its usual situation being covered by smooth skin, of natural colour, continued from the perineum over the buttocks." An attempt was made to open the bowel by incision, which was carried more than two inches in depth, without the object being accomplished. On the fourth day from the child's birth, fæces were observed to pass by the urethra, and in a fortnight afterwards they began to pass freely, in which condition the child lived till it was eight months and twenty-two days old.

No

Dr. N. Chevers † had a male child, five days old, brought to him by its father, a Hindoo ryot. indication of an anal aperture existed; the abdomen was much distended. An operation was performed, and a small canula introduced into the bowel. On the following day feculent matter was observed to

pass by the urethra. The case terminated fatally on

the thirteenth day after the operation. An examina*Medical Gazette,' New Series, vol. ii., p. 767. † Op. cit., p. 297.

tion of the parts was made, and "a narrow duct passing from the fore part of the intestinal cul-de-sac into the neck of the bladder, or membraneous portion of the urethra," was found to exist.

When the rectum terminates in the urethra, the surgeon must endeavour to dissect down upon the extremity of the intestine, and establish a more convenient and larger opening than that formed by nature. If the urethra opens in the under part of the penis, as is not uncommonly the case, it may be possible to pass a probe into the intestine, which may be felt by the finger in the wound, and then cut upon. But if the intestine terminates in the bladder, the operation must be conducted in the same manner as if the rectum were wanting. It has been recommended to cut into the neck of the bladder, but a successful issue would be more than doubtful.

IN THE VAGINA.

When the rectum terminates in the vagina, the opening is much larger than when it terminates in the urethra. This form of malformation will also admit more easily of being remedied than that forming the subject of the previous section of this chapter, and may be situated either in the posterior or lateral wall of the vagina.

Although there is a greater probability of an infant living with this condition of parts, yet much suffering and inconvenience must arise from it: thus the mucous membrane will be excoriated, ulceration induced, and abscess may form in the adjacent cellular tissue.

Should the rectum terminate in a pouch, an opening from the natural position of the anus may very readily be made into it, by passing a blunt hook or bent probe through the recto-vaginal aperture, and rendering its extremity salient in the perineum, which will then be a guide for the knife. The artificial opening must be kept patent by tents and bougies. But sometimes the rectum tapers considerably before opening into the vagina: in which case an incision must be carried backward to a sufficient extent through the portion of the vaginal partition that is below the opening; a canula is then to be passed into the bowel, and retained by tapes. The anterior part of the wound is to be brought together by sutures; great attention to cleanliness will be necessary to promote the union of that which is to form the recto-vaginal septum.

Imperforate anus; the rectum opening into the vagina.

Mrs. B, in consequence of fright, from the house in which she lived taking fire, prematurely gave birth, when seven months and a half advanced in pregnancy, to a female child.

It was diminutive, and its vital powers were low. For the first few days no malformation was suspected, as meconium and small quantities of fæces had passed; but the child at length appearing to suffer pain, and the abdomen becoming distended, an examination was made, when it was discovered that the anus was imperforate, and that feculent matter passed per vaginam. No means were taken to remedy the condition of the parts.

When the child was about four weeks old, it came under the observation of Dr. Gibb, who desired the mother to consult me she accordingly brought her baby to my house. On making an examination, there was no indication of an anus, the integument being continuous from side to side: at about the junction of the sacrum and the coccyx a depression existed, but no sinus or canal led from it. Externally, no other defect in its development was to be observed. Separating the vulva, at a quarter of an inch within the vagina, an opening was seen large enough to admit a number ten catheter: through this excrementitious matter oozed; a bent probe passed through it, and its point pressed downward, could be indistinctly felt externally. On considering the nature of the case, I proposed to establish an opening in the intestine more conveniently situated than that formed by nature. The parents being very desirous to have anything done that offered a probability of remedying the defect and saving the child, gave a willing consent that I should perform the necessary operation.

Dr. Gibb fully concurring in my views, with his kind assistance I operated on the infant the day following that on which I first saw it. The child being held with the perineum