dinary imperforation of the anus, in which the rectum
terminates in the middle of the sacral cavity. The rectum may be
deficient from the superior third of the sacrum, and in this position
is quite inaccessible for operation.

A compensatory coalition of the bowel with the bladder or urethra is
sometimes present, and in these cases the feces are voided by the
urinary passages. Huxham mentions the fusion of the rectum and colon
with the bladder, and similar instances are reported by Dumas and
Baillie. Zacutus Lusitanus describes an infant with an imperforate
membrane over its anus who voided feces through the urethra for three
months. After puncture of the membrane, the discharge came through the
natural passage and the child lived; Morgagni mentions a somewhat
similar case in a little girl living in Bologna, and other modern
instances have been reported. The rectum may terminate in the vagina.
Masters has seen a child who lived nine days in whom the sigmoid
flexure of the colon terminated in the fundus of the bladder. Guinard
pictures a case in which there was communication between the rectum and
the bladder. In Figure 140 a represents the rectum; b the bladder; c
the point of communication; g shows the cellular tissue of the scrotum.

There is a description of a girl of fourteen, otherwise well
constituted and healthy, who had neither external genital organs nor
anus. There was a plain dermal covering over the genital and anal
region. She ate regularly, but every three days she experienced pain in
the umbilicus and much intestinal irritation, followed by severe
vomiting of stercoraceous matter; the pains then ceased and she
cleansed her mouth with aromatic washes, remaining well until the
following third day. Some of the urine was evacuated by the mammae. The
examiners displayed much desire to see her after puberty to note the
disposition of the menstrual flow, but no further observation of her
case can be found.

Fournier narrates that he was called by three students, who had been
trying to deliver a woman for five days. He found a well-constituted
woman of twenty-two in horrible agony, who they said had not had a
passage of the bowels for eight days, so he prescribed an enema. The
student who was directed to give the enema found to his surprise that
there was no anus, but by putting his finger in the vagina he could
discern the floating end of the rectum, which was full of feces. There
was an opening in this suspe