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It was diminutive, and its vital powers were low. For the first few days no malformation was suspected, as meconium and small quantities of faeces 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 vulvae, 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 presenting, a strong probe bent was passed through the rectovaginal opening, the point being pressed firmly towards the surface; an incision three-quarters of an inch long was made through the integument midway between the commissure of the vagina and the point of the coccyx; the point of the probe was then cut on and brought through the wound. I now discovered that the communication between the bowel and the vagina was by a narrow tube, and that by firm pressure at the bottom of the wound the pouch of the intestine could be indistinctly felt pressing downward when the child strained. The incision was cautiously continued to a depth of an inch and three-quarters, when the bowel was reached, and a puncture made with the point of the scapel: a probepointed bistoury being then introduced, and the opening enlarged so as freely to admit the finger, on the withdrawal of which a considerable quantity of faeces were discharged. About two ounces of blood were lost during the operation. A full-sized lithotomy tube was secured in the wound; and retained for eight days, being removed only when it was necessary to clean it, and in examination of the parts. The artificial opening evinced a strong tendency to contraction, which was counteracted by the daily introduction of the finger for the first fortnight, and subsequently a number four rectum bougie which has been introduced and retained for some minutes daily. The bowel is also washed out with three ounces of thin gruel. The child is now +wo years and a half old, and has progressed most favourably; its health is good, it feeds well, and the bowels act freely, and it has control over them. The size of the bougie has been gradually increased.
Mr. Mantell* operated, in September, 178C, on a female child with imperforate anus: a small opening existed between the rectum and vagina. In the spring of 1788, he had to repeat the operation in consecpience of the closure of the artificial anus: another surgeon had previously performed the operation for the second time.
Mr. Copland Hutchinsonf was consulted respecting a female child, four weeks old, in whom the anus was occluded, and a communication existed between the rectum and vagina, through which the fieces passed freely. The mother would not consent to any operation. Mr. Bathurst, of Strood, had a child under his care in whom the faeces passed per vaginam; there was also an external opening at the anus, but not larger than would admit a probe; it was dilated by bougies, and the -abnormal aperture between the rectum and vagina closed spontaneously.
OPENING IN THE SACRAL REGION.
La Faye, in page 358 of 'Principes de Chirurgie,' records a case of deficiency of a portion of the sacrum, the rectum opening at the lower part of the back.
* 'Memoirs of the Medical Society of London,' vol. iii., pp. 389 392.
j Op. t-it., p. 265.
TERMINATING IN A COMMON OPENING WITH THE
As Andral expresses himself, there sometimes appears to be a tendency in the terminal orifices of the digestive, urinary, and genital canals to be confounded together in a cavity more or less analogous to the cloacae of birds. Sometimes the urethra occupies its normal position, and the recto-vaginal septum may be partially or entirely absent. All these malformations depending of course on an arrest in the development in various degrees of one or other of the stages through which the parts pass in their formation.
OTHER ORGANS TERMINATING IN THE RECTUM.
The lusus of the ureters opening into the rectum has been seen, but it is an anomalous condition extremely rare.
Habitual constipation is one of the most prevalent and troublesome functional disorders to which mankind is subject. Its sympathetic effects extend to every organ of the body, and often occasion great distress and anxiety to the sufferers, leading them to apprehend the existence of the most serious organic disease. Neither can it be doubted that many of the pathological changes in structure of the viscera of the head, chest, and abdomen, have their origin in functional derangement, induced either sympathetically by constipation and consequent derangement of the assimilative organs, or by the retention of excrementitious matter. Of the sympathetic effects on the brain and nervous system thereby induced we have evidence during infancy and youth in convulsive fits, chorea, and other nervous affections, and in adults in the giddiness, drowsiness, headache, pains extending to various parts of the body, and that distressing