Remarks. Large calculus 1 inches in length, and 14, in thickness. No control over bladder after operation for several days. Patient made perfect recovery. Perfect control over bladder. i (Communicated by that surg.) Phosphatic calculus, of an inch in diameter. (Communicated by Dr. Lente.) Recovery in 20 days. Stone 1 inch in diameter. bladder. Stone adherent to (Communicated by Dr. Hutchinson.) Stone, diameter 16, 1%, and 1 inch. Weighed 200 grains. Wound healed in eleven days. Calculus 14 inches largest diameter; difficulty in extraction; 24 hours after, could hold his urine. Water all came through natural channel after 14th day. Shot through rectum and bladder. Wound had healed, but had trouble in passing water. Several fragments of bone passed urethra, and 6 months before operation, a fragment of bone lodged in urethra, and membranous portion of urethra opened, and bone extracted, and on passing finger in bladder, stone was found, the nucleus was a spicula of bone. (Communicated by Dr. Krackowizer.) Stone weighed 55 gr'ns. Phosphatic. Stone weighed 79 grains. Flat stone which had been adherent to bladder. Two small calculi. Followed by stricture of urethra, which was relieved by ope ration. Slight dribbling from wound for few days. Passed all his urine through urethra, none passing through wound after operation. Oxalate of lime calculus. Two calculi, size of hazel-nuts. The operation was performed only to relieve the severe sufferings of patient. There was no expectation at the time that he would recover from his feeble condition. Died third day after operation from exhaustion. Septicemia, third day after ope ration NEW OPERATION FOR IMPERFORATE ANUS. IN October, 1867, I was called in consultation with Dr. Thos. A. Healey, to see Mary M―n, æt. 5 months, Irish descent, light complexion and hair; laboring people; healthy, and have no history of malformation in either of their families. She was suffering with retention of feces. Examination showed there was no anus. The rectum swept over the perineum and opened at the "fossa navicularis." This abnormal opening resembled a preternaturally small anus, measuring from verge to verge of its cup-shaped depression nearly two lines. By using slight distending force, an opening could be made pervious into the rectum, of this diameter. The introduction of a probe showed this abnormal anus was possessed of a sphincter muscle, by resisting its entrance and by grasping it quite firmly, when within, especially when the probe was allowed to remain quiet for a few moments. At the least touch, the anus would be retracted or drawn up, showing the existence of a levator muscle. The site of the usual opening of the anus was occupied by a slightly elevated circular patch of a delicate pink color, seven lines in diameter. I then advised, and two months later, assisted by Drs. C. H. Ohr, E. P. Duval, and Geo. B. Fundenberg, performed the following operation for its relief. For convenience, I will call the abnormal opening of the rectum the "anus," divide the different procedures in the operation into steps, and use the term "circular cut" when referring to the incision made in step first. The child was chloroformed by Dr. Ohr, tied in the same way as for the operation of lithotomy, and placed on a narrow table in a clear, bright light. Step 1. The first step in the operation was the drawing forward by a tenaculum, and cutting away, with a pair of curved scissors, the rosy elevation of the cuticle, before mentioned. Step 2. A pointed bistoury was entered in the raphé, about a line from the posterior verge of the "anus," slid under the skin and brought out into the "circular cut." Step 3. A large female catheter was placed in the rectum, and an angular incision made which was bounded posteriorly by a straight line, running from the posterior edge of the "circular cut" toward the promontory of the sacrum, and anteriorly by the posterior surface of the rectum. The tissues here were white and yellow, elastic fibres of connective tissue interlaced, tough to cut and not to be torn. Step 4. The anus were circumscribed by an incision half a line from its verge. The vaginal mucous membrane dissected up from the rectum for about six lines, and the tissues around the rectum incised so as to allow the gut to be moved back into the channel made in the previous step, and to permit the attachment of the edges of the "anus" to the edges of the "circular cut." The incisions made here, all pointed toward the walls of the pelvis and away from the intestine. Step 5. The "anus" was made fast by eight interrupted sutures to the edges of "circular cut," beginning on either side the raphé posteriorly. The circle for its attachment was completed by Step 6. Passing in a curved needle, armed with heavy silver wire, at a point five lines from the edge of the cut raphé and equidistant from the fourchette and "circular cut" wall, back in the tissues to the bottom of the fissure now existing between the vagina and rectum, and out on the other side symmetrically with the point and course of entrance. This fissure was then closed and kept so by means of shot clamped on either end of the wire, and the gut was sewed fast to the now completed circle. Two or three stitches were put in the raphé. The child being released from its bandages, the knees and feet were loosely bound together and cold water cloths applied to the cuts. She was ordered sufficient laudanum (given in increasing doses) to control any bearing-down efforts, and although this treatment was pushed until decided narcosis was produced, the bearing down and straining came on at regular intervals, and finally became almost continuous. On the third day, Dr. C. H. Ohr and myself found, on examination, that the pressure exerted by the straining had drawn one of the large duck shot through the skin and dense structures beneath to the bottom of the chasm it was intended to close, the sutures in the raphé had cut out, and only four sutures held the "anus" in its |