This case, I believe, is out of the ordinary and, as far as the literature to which I have access reveals, and in view of the age of the subject, unparalleled. The etiology I cannot explain without considering the possibility of congenital defects and lack of tone due to the condition of the bowel at birth.
—A girl, aged 13, American, born with an imperforate anus, the feces draining through the vagina, was operated on five years before I saw her, and the anus established at the normal location. In the absence of a sphincter, there had been incontinence. The anus was dilated several times in the two years following the operation, but there had been no trouble since that time. At one of the dilations the ampulla of the rectum was found loaded, and was cleaned out. The patient had not had the usual diseases of children. She