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A CASE OF IMPEKFOEATE ANUS OPERATED UPON FOR THE FIRST TIME ON THE TWENTY-SEVENTH DAY AFTER BIRTH. By OSCAR J. COSKERY, M. D., PROFESSOR OF SCRGERY IN THE COLLEGE OF PHTSICIANB AND BURGEONS, 40 Mg Of Levitra Too Much BALTUIORB. On December 10, 1885, I first saw the male eliiW of Mrs. H. He was then twenty-six days olfl, and the history the mother gave me was as follows : Since birth no evacuation of the bow- els had taken place. For the first day or two the child had had some difficulty in nursing, but since then had nursed well, al- though some of the milk taken into the stomach was generally thrown up. On the fourteenth day vomiting of very offensive matter occurred, and continued until the evening of December 9^ 1885 — the day before I saw the child. I found a very weak, puny child, with a much disteuded abdomen, the superficial ves- sels engorged, and the movements of the intestines plainly to be seen. There was a large accumulation of gas also. Where the anus should have been was a cul-de-sac about half an inch in depth. The little finger introduced into this 'seemed to give pain. No fluctuation could be felt above the sac. On the next day, December 11, 1885, or twenty-seven days after birth, a good-sized cannula and trocar were introduced into the cul-de-sac and pushed upward for, probably, half an inch be- fore resistance was overcome. The trocar being withdrawn, about one third of a teacupful of frecal matter escaped. When all that woidd come in this vpay ha40 Mg Of Levitra Too Much evacuations had been regular, except upon one occasion, when a small dose of castor-oil had been given with snccess, until the day before (January 7th), when only one scanty discharge had occurred. Any attempt to 40 Mg Of Levitra Too Much pass a director up the bowel resulted in failure. The abdomen was again greatly distended, the child was very restless and fretful, and vomiting, not stercoraceous, had come on. On January 9, 1886, or fifty-seven days after the birth of 40 Mg Of Levitra Too Much the child, the large cannida was again used. Through it, aided COSKERY: A CASE OF IMPERFORATE ANUS. [N. Y. Mkd. Jouk., by injections of warm water, about half a small teacupful of freeal matter and a large quantity of pas were discharged from the bowel. A drainage-tube was introduced into the anus, but I could not satisfy myself that it entered the howel properly, and, on account 40 Mg Of Levitra Too Much of the irritation of the external sphincter pro- duced by its presence, it was withdrawn. Very little bleeding followed the operation, notwithstanding the fact that the trocar was introduced fully two inches. I should mention here that tlie child had wonderfully picked up since the operation of 40 Mg Of Levitra Too Much De- cember 12, 1885. It had nursed well, slept well, and greatly increased in size, being now a rather healthy looking child for its age — two months. January lOtJi. — Very little faecal matter had escaped since yesterday. Two directors were introduced and a small quan- tity came away. By separating the directors the opening was enlarged. As operative interference seemed to irritate the child, noth- ing further was done until on January 17th. During this time the abdomen had increased in 40 Mg Of Levitra Too Much size enormously, vomiting had occurred after nearly every nursing (simply of the contents of the stomach), and the napkins were only slightly stained. On this date (January 17th, or sixty-four days after birth), under chloroform, a dressing forceps was introduced and expanded. The forceps was withdrawn and the dilator for the female urethra introduced by Dr. Robert T. Wilson, of this city, was passed with some little difficulty. The blades were separated as far as possible (about half an inch), and gas and fseeal matter escaped. The nozzle of a syringe was introduced, and the in- jection of warm water brought away a quantity of feeces. ISth. — Thecliild has had ten copious evacuations. The belly is flat, lie has nursed well, has not vomited since the operation of yesterday, and has slept quietly. February 1st. — Since the last note the stools have been ir- regular ; sometimes copious, at 40 Mg Of Levitra Too Much other times very small and few in the twenty-four hours. On this date the unclosed opening was again dilated under chloroform, so as to admit the little finger, but very little faecal matter escaped. In the next twenty-four hours the child had six good-sized evacuations, and did not vomit at all (vomitinff of small quantities of milk, for a week before February 1st, had been constant). 16th. — Since the last note the stools have 40 Mg Of Levitra Too Much been irregular — sometimes five in the twenty-four hours, at other times none. For the last forty-eight hours no stool has passed, and vomiting has returned. The vomited matter is said by the parents to be offensive, but colorless. Again the parts were dilated, under chloroform, and a half-inch-diameter drainage-tube was intro- duced well into the rectum. The tube was secured in position by means of adhesive plaster, and the bowel washed out with warm water. This brought away a large quantity of fsecal matter and 40 Mg Of Levitra Too Much gas. Two hours afterward the tube was displaced and not inserted again. The bowels continued to act well through the artificial anus. March 3d. — During the preceding two days only one stool has occurred, and with great straining. The parts were again