traumatism. Paterson reports
a case of congenital hernia of the stomach into the left portion of the
thoracic cavity. It was covered with fat and occupied the whole left
half of the thoracic cavity. The spleen, pancreas, and transverse colon
were also superior to the diaphragm. Death was caused by a well-defined
round perforation at the cardiac curvature the size of a sixpence.

Anomalies of the Intestines.--The Ephemerides contains the account of
an example of double cecum, and Alexander speaks of a double colon, and
there are other cases of duplication of the bowel recorded. There is an
instance of coalition of the jejunum with the liver, and Treuner
parallels this case. Aubery, Charrier Poelman, and others speak of
congenital division of the intestinal canal. Congenital occlusion is
quite frequently reported.

Dilatation of the colon frequently occurs as a transient affection, and
by its action in pushing up the diaphragm may so seriously interfere
with the action of the heart and lungs as to occasionally cause
heart-failure. Fenwick has mentioned an instance of this nature.
According to Osler there is a chronic form of dilatation of the colon
in which the gut may reach an enormous size. The coats may be
hypertrophied without evidence of any special organic change in the
mucosa. The most remarkable instance has been reported by Formad. The
patient, known as the "balloon-man," aged twenty-three at the time of
his death, had had a distended abdomen from infancy. Postmortem the
colon was found as large as that of an ox, the circumference ranging
from 15 to 30 inches. The weight of the contents was 47 pounds. Cases
are not uncommon in children. Osler reports three well-marked cases
under his care. Chapman mentions a case in which the liver was
displaced by dilatation of the sigmoid flexure. Mya reports two cases
of congenital dilatation and hypertrophy of the colon (megacolon
congenito). Hirsohsprung, Genersich, Faralli, Walker, and Griffiths all
record similar instances, and in all these cases the clinical features
were obstinate constipation and marked meteorismus.

Imperforate Anus.--Cases in which the anus is imperforate or the rectum
ends in a blind pouch are occasionally seen. In some instances the
rectum is entirely absent, the colon being the termination of the
intestinal tract. There are cases on record in which the rectum
communicated with the anus solely by a fibromuscular cord. Anorectal
atresia is the or