small, and permits only the more fluid portion of the meconium to be evacuated.

In other instances, the intestine opens into the bladder somewhere between its neck and the part where the ureters enter; in such cases the meconium and urine will be mixed; but when the opening is urethral, a jet of meconium, or fæcal matter, will generally precede the urine.

In this species of malformation, the opening for the discharge of the contents of the bowel being so small, the child rarely survives more than a week, but instances are recorded of life being prolonged beyond that. Fortunatus Licetus mentions a woman who voided her fæces through the urethra. Flaginit relates the case of an infant in whom about three inches of the rectum was wanting, the intestine terminating in a canal four inches in length, which passed under the prostate gland, and opened into the membranous portion of the urethra. The stercoraceous matter of course was voided with great difficulty by the urethra, nevertheless, the miserable babe lived eight months, and then only died in consequence of having swallowed a cherrystone which lodged in the recto-urethral canal. Bravais‡

* De Monstorum Causis Natura et Differentiis,' lib. ii,

1616.

+ 'Osservazione di Chirurgia,' tome iv, obs. 39.

Actes de Lyon,' tome iv, p. 97.

cap. liii,

records the case of a boy four years and a half old, in whom the rectum, after becoming very narrow, opened into and appeared continuous with the urethra. Paulletier also saw a similar case in a boy three years and a half old.

*

Mr. Copland Hutchinson+ operated on a male child, born forty-eight hours. An incision was first made to the depth of an inch and a half, then a trocar and canula were inserted another inch and half, when the intestine was reached; the opening was maintained by tents and bougies. After three months, the urine was observed to be tinged with fæces; it had not been observed to pass per anum. The child died when about

ten months old from the irritation of dentition. An examination revealed a valvular opening between the rectum and commencement of the urethra.

Mr. Fergusson reports a very interesting case of a male child, born twelve hours previously to coming under his observation. No anus existed, but the skin where it should have been had a brownish appearance; above this, at a considerable distance from the surface, an indistinct tumour could be felt. An incision was made to the depth of an inch and a half, but the bowel

* 'Diction. de Scienc. Méd.,' tome iv, p. 157.

Op. cit., p. 264.

Edinburgh Medical and Surgical Journal,' vol. xxxvi; and 'Practical Surgery,' Third Edition, p. 740.

was not reached, nor could it be felt. The next day meconium being observed to pass by the urethra, Mr. Fergusson determined to cut into the bladder, and he opened this viscus immediately behind the prostate. The boy died of disease of the lungs, when about six years old.

:

Mr. Windsor,* of Manchester, relates a case of ascites in a fœtus born at the full period; there was malformation of the rectum, and other viscera, and absence of the anus. The colon was nine and a half inches in length it passed in a straight line down the spine, terminating in a constricted tube, which barely admitted the passage of a blowpipe; this constricted part opened into a pouch the size of a hen's egg, occupying the portion of the rectum, and between which and the bladder a communication existed by a canal half an inch in length.

Mr. Randolph, of Hungerford, records in the 'Lancet,' the particulars of a male child born without any opening in the anal region. Small quantities of meconium were observed to pass per urethram. The infant died on the ninth day. No operation was undertaken for its relief, as the mother objected. By examination after death, the rectum was found to open into

the bladder immediately posterior to the prostate gland.

6

* Edinburgh Medical and Surgical Journal,' vol. xvii,

+ Vol. i, 1838-9, p. 162.

Mr. Lizars,-quoted by Mr. Fergusson,*-made an opening into the rectum of a child born with imperforate anus; he had to cut deeply before the intestine was reached. A communication between the rectum and bladder existed. The child lived three weeks; from the time of its birth, a tumour existed over the 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

* 'Edinburgh Medical and Surgical Journal,' vol. xvii, p. 367. + Lancet,' vol. i, 1835-6, p. 373.

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

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 three eighths 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 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 perinæum 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.

Dr. N. Chevers† had a male child, five days old, brought to him by its father, a Hindoo ryot. No indi

* Medical Gazette,' New Series, vol. ii, p. 767.

Op. cit., p. 297.