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stretched, without chloroform, and, on syringing the bowel, about a gill of fiecal matter was brought away. For the last week vomiting has occurred at times, sometimes offensive (ac- cording to the mother's account), but not colored. The abdo- men is not very tense, and the child has wonderfully improved in appearance. 17th.— Vp to March 9th it was necessary to give injections of warm water in order to relieve the bowels, but since then the child has had unaided evacuations daily, but with some straining. To-day I noticed, for the first time, that the child had the snuffles, and the mother informed me (hat it had had a " cold " since it was born. Tlie histories Cheapest Generic Levitra of the parents were almost above suspicion, and there were no other signs, but I thought it advisable to prescribe potassic iodide in one-grain doses every Cheapest Generic Levitra three hours. The child has improved since the last note in every way. ^4^^. — For the last three days very little fsecal matter Cheapest Generic Levitra has been extruded, and the father has not been able to intioduce the nozzle of the syringe into the bowel. On this date, again under chloroform, after considerable trouble, I was able to gel in the urethral dilator, and exjianded the parts fully three quar- ters of an inch. The fteces were very tenacious, having to be broken up with a director, and then washed out with warm water. In this way about a third of a teacupful was removed. Vomiting, not offensive, mostly of curdled milk, has existed for the last four days, and the abdomen was much distended before the operation. The snuffling has not improved Cheapest Generic Levitra under the iodide. S7th. — Dilatation with graduated bougies was commenced. Very slight improvement since the last operation. April 1st. — Under the use of the bougies and injections, the bowels are moved two or three times in the twenty-four hours, and the child seems to be doing so well at this time that the par- ents refuse to allow Cheapest Generic Levitra of further operative measures. No vomit- ing. May 1st. — Under the foregoing treatment the Cheapest Generic Levitra child has gained flesh, and, with a few variations, has averaged two evacuations daily. 25th. — The stools are not so numerous or large as some time ago, but the child is passing enormous quantities of water, and is physically improving. 30th. — The child is now having regularly two stools a day without any artificial assistance. The most important point in this case is the length of time after birth that the child went withoiit any relief from the fsecal accumulation — four weeks. The literature Cheapest Generic Levitra upon this point, that I have been able to find, is not very large. In Chelius's " Surgery," vol. iii, p. 34, a case is mentioned in which, after an unsuccessful at- tempt with a lancet, a pharyngotome was introduced on the twelfth day, " and, by the use of clysters and tents, the child ultimately recovered." In " Lectures upon Diseases of the Rectum," by Van Buren, New York, 1881, on page 365 we find the follow- ing Cheapest Generic Levitra : " Asliton reports Cheapest Generic Levitra the case of an imperforate child who died on the eighth day of peritonitis, unrelieved " (" Trans, of the Path. Soc. of London "). Jonathan Hutchinson : " Another case of death on the eighth day, while those in charge were hesitating about an operation." Bryant, " Practice of Surgery," page 522, says : " Mr. R. Harrison, of Liverpool, records the case of a child who was born with an Cheapest Generic Levitra imperforate anus, and was successfully operated upon Cheapest Generic Levitra in the anal region thirty-three days after birth " (" Lancet," February 26, 1876). Another case is reported in the London " Lancet " of May 15, 1880, in which, on the thirty-third day, Mr. Willet punctured the septum but drew off only serous fluid, and the child died of peritonitis. Surgeon J. S. Billings, IT. S. Army, has kindly fur- nished me tlie following references to similar cases : "1. De la Marc. Observation sur Vanus imperfor6 d'un en- fant de six Cheapest Generic Levitra inois. ' m6d.-chir.,' etc., Paris, 1770, vol. xxxiii, p. 510. "2. Cleveland. Case of imperforate anus; child lived up- ward often weeks without relief from the bowel after two un- July 3, 1886.] BLETTHING: A CASE OF EXTRA-UTERINE FCETATION. successful operations. ' Trans, of the Obstet. Soc. of Lend.,' 1867, vol. ix, p. 203. '•3. Pricbai-d. Imperforate anus; life prolonged to the 102d day without evacuation. ' Prov. Med. and Surg. Jour.,' Lond., 1851, p. 123." In conneetiou with Cheapest Generic Levitra the cases of late operatioii, it is, prohably, admissible to quote the following from Van Bu- ren, page 365. He says : "An infant with complete imperforation is necessarily doomed to early deatb. This takes place sooner or later, ac- cording to its physical powers, generally within ten days, and its immediate cause is peritonitis from over-distension, aided by septicairaic poisoning by the retained excretions." And again, on page 369, while insisting upon the great importance of seeing that the gut is free, he uses the follow- ing language : " I repeat this intentionally, for neglect to early discover this variety of malformation will Cheapest Generic Levitra gravely imperil the chances of sav- ing the life of the infant by surgery. Death is inevitable with- in a few days (italics are Cheapest Generic Levitra mine) unless relief is at hand ; and, vvbtn the child refuses the breast and begins to fret and worry with colicky pains on the third day, changes have already be- gun which may interfere with the success of surgical treat- ment." Cheapest Generic Levitra A CASE OF EXTEA -UTERINE FCETATION; FARADIZATION ; RECOVERY. By GEORGE DAORE BLEYTHING, M. D. Mns. M., aged twenty-three, born in New York of German