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ifice； and； on introducing the finger along the anterior wall of the rectum； a fistula was found； communicating with the vagina； above this point the arrangement and the situation of the parts were normal。 The woman had given birth to three still…born children； and always menstruated easily。 Coitus always seemed satisfactory； and no suspicion existed in the patient's mind； and had never been suggested to her； of her abnormality。
Harrison saw a fetus delivered by the anus after rupture of the uterus； the membranes came away by the same route。 In this case the neck of the uterus was cartilaginous and firmly adherent to the adjacent parts。 In seven days after the accouchement the woman had completely regained her health。 Vallisneri reports the instance of a woman who possessed two uteruses； one communicating with the vagina； the other with the rectum。 She had permitted rectal copulation and had become impregnated in this manner。 Louis； the celebrated French surgeon； created a furore by a pamphlet entitled 〃De partium externarum generationi inservientium in mulieribus naturali vitiosa et morbosa dispositione； etc。；〃 for which he was punished by the Sorbonne； but absolved by the Pope。 He described a young lady who had no vaginal opening； but who regularly menstruated by the rectum。 She allowed her lover to have connection with her in the only possible way； by the rectum； which； however； sufficed for impregnation； and at term she bore by the rectum a well…formed child。 Hunter speaks of a case of pregnancy in a woman with a double vagina； who was delivered at the seventh month by the rectum。 Mekeln and Andrews give instances of parturition through the anus。 Morisani describes a case of extrauterine pregnancy with tubal rupture and discharge into the culdesac； in which there was delivery by the rectum。 After an attack of severe abdominal pain； followed by hemorrhage； the woman experienced an urgent desire to empty the rectum。 The fetal movements ceased； and a recurrence of these symptoms led the patient to go to stool； at which she passed blood and a seromucoid fluid。 She attempted manually to remove the offending substances from the rectum； and in consequence grasped the leg of a fetus。 She was removed to a hospital； where a fetus nine inches long was removed from the rectum。 The rectal opening gradually cicatrized； the sac became obliterated； and the woman left the hospital well。
Birth Through Perineal Perforation。Occasionally there is perineal perforation during labor； with birth of the child through the opening。 Brown mentions a case of rupture of the perineum with birth of a child between the vaginal opening and the anus。 Cassidy reports a case of child…birth through the perineum。 A successful operation was performed fifteen days after the accident。 Dupuytren speaks of the passage of an infant through a central opening of the perineum。 Capuron； Gravis； and Lebrun all report accouchement through a perineal perforation； without alteration in the sphincter ani or the fourchet。 In his 〃Diseases of Women〃 Simpson speaks of a fistula left by the passage of an infant through the perineum。 Wilson； Toloshinoff； Stolz； Argles； Demarquay； Harley； Hernu； Martyn； Lamb； Morere； Pollock； and others record the birth of children through perineal perforations。
Birth Through the Abdominal Wall。Hollerius gives a very peculiar instance in which the abdominal walls gave way from the pressure exerted by the fetus； and the uterus ruptured； allowing the child to be extracted by the hand from the umbilicus； the mother made a speedy recovery。 In such cases delivery is usually by means of operative interference （which will be spoken of later）； but rarely； as here； spontaneously。 Farquharson and Ill both mention rupture of the abdominal parietes during labor。
There have been cases reported in which the recto…vaginal septum has been ruptured； as well as the perineum and the sphincter ani； giving all the appearance of a birth by the anus。
There is an account of a female who had a tumor projecting between the vagina and rectum； which was incised through the intestine； and proved to be a dead child。 Saviard reported what he considered a rather unique case； in which the uterus was ruptured by external violence； the fetus being thrown forward into the abdomen and afterward extracted from an umbilical abscess。
Birth of the Fetus Enclosed in the Membranes。Harvey says that an infant can rest in its membranes several hours after birth without loss of life。 Schurig eventrated a pregnant bitch and her puppies lived in their membranes half an hour。 Wrisberg cites three observations of infants born closed in their membranes； one lived seven minutes； the other two nine minutes； all breathed when the membranes were cut and air admitted。 Willoughby recorded the history of a case which attracted much comment at the time。 It was the birth of twins enclosed in their secundines。 The sac was opened and； together with the afterbirth； was laid over some hot coals； there was； however； a happy issue； the children recovering and living。 Since Willoughby's time several cases of similar interest have been noticed； one in a woman of forty； who had been married sixteen years； and who had had several pregnancies in her early married life and a recent abortion。 Her last pregnancy lasted about twenty…eight or twenty…nine weeks； and terminated； after a short labor； by the expulsion of the ovum entire。 The membranes had not been ruptured； and still enclosed the fetus and the liquor amnii。 On breaking them； the fetus was seen floating on the waters； alive； and； though very diminutive； was perfectly formed。 It continued to live； and a day afterward took the breast and began to cry feebly。 At six weeks it weighed 2 pounds 2 ounces； and at ten months； 12 pounds； but was still very weak and ill…nourished。 Evans has an instance of a fetus expelled enveloped in its membranes entire and unruptured。 The membranes were opaque and preternaturally thickened； and were opened with a pair of scissors； strenuous efforts were made to save the child； but to no purpose。 The mother； after a short convalescence； made a good recovery。 Forman reports an instance of unruptured membranes at birth； the delivery following a single pain； in a woman of twenty…two； pregnant for a second time。 Woodson speaks of a case of twins； one of which was born enveloped in its secundines。
Van Bibber was called in great haste to see a patient in labor。 He reached the house in about fifteen minutes； and was told by the midwife； a woman of experience； that she had summoned him because of the expulsion from the womb of something the like of which she had never seen before。 She thought it must have been some variety of false conception； and had wrapped it up in some flannel。 It proved to be a fetus enclosed in its sac； with the placenta； all having been expelled together and intact。 He told the nurse to rupture the membranes； and the child； which had been in the unruptured sac for over twenty minutes； began to cry。 The infant lived for over a month； but eventually died of bronchitis。
Cowger reports labor at the end of the seventh month without rupture of the fetal sac。 Macknus and Rootes speak of expulsion of the entire