CASES of congenital intestinal atresia are comparative] rare, hence I venture to record the two following cases whic. have recently been under my care. CASE 1.-The patient was a female infant, aged six days She was born with a prominent navel. Since birth she hal passed nothing per rectum and had passed very little urine Vomiting commenced shortly after birth and persisted i) increasing severity. The vomit latterly was dark brown ii colour and very offensive. When seen on the sixth day o life

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... ere was a congenital umbilical hernia about thre. inches in diameter ; the shrunken and blackened remains o the funis were attached to the summit of this. The cover ings of the hernia had a dull yellowish, opaque appearance and passed on in continuity with the skin of the abdominal wall which formed no part of the covering of the hernia There was an offensive odour as if the bowel might have given way. The abdomen was distended and many coils ir peristalsis could be seen. The rectum was well formed. The diagnosis made was a snaring of the intestine in the umbilical cord. No attempt was made to reduce the hernia, although a coil of intestine was felt in the sac ; on the suspicion that it was leaking it was considered better to operate at once without any attempt at reduction. An incision was made around the base of the hernia and above the latter in the mid-line of the abdomen. The peritoneal cavity was opened above the sac after ligature of the umbilical vessels. The intestine entering the hernial sac was exposed and an attempt was made to withdraw this. This was unsuccessful and the sac was therefore slit up and the adherent intestine was separated. It was then noticed that this intestine ended blindly in the sac ; there was no loop returning to the abdominal cavity. The intestine was clamped and the whole sac was removed. I then drained the small intestine and again clamped it. I now tried to find some large intestine with which to anastomose the ileum. Feeling first in the right iliac fossa and then on the left side and pelvis I was unable to find any. I then drew all the intestines outside of the abdominal cavity but still I could find no intestine otherwise than the dilated upper portion. I then drew the stomach down into the wound to find the transverse colon and found crossing the lower border of the stomach a narrow cord about half to one-third of an inch in diameter. This represented all I could find of the large intestine, which appeared to me much too small to admit of anastomosis and at this stage also the infant's condition prevented this treatment. The intestines were replaced and a Paul's tube was tied in the opened end. The infant died some few hours later. On examining the sac afterwards it was seen that coming off from the lower part of the distended intestine in the sac was a small diverticulum which appeared to have been ligatured in the cord from its dense adhesion in this region. This could not be definitely proved as advanced inflammatory changes had already taken place in the coverings of the hernia. Prolonged from the apparently blind end of the small intestine was a small cord-like structure about two inches in length, which on further examination was found to have a narrow lumen admitting a surgical probe and ending blindly. This lumen was apparently continuous with the lumen of the small intestine. At the necropsy the large intestine commenced just below the hepatic flexure; the transverse colon, sigmoid flexure, and rectum were all present but very shrunken, having a diameter of from one-third to half an inch and a narrow lumen. The contents were merely a little colourless mucus. In the sac of the hernia, therefore, there was the lowest coil of small intestine, from which a diverticulum arose and was probably ligatured in the cord; beyond this point the intestine which represented the cascum and ascending colon was much contracted, and although having a lumen it was too small to permit of the onward passage of contents. The intestine ended blindly in. the sac and the large intestine commenced again just below the hepatic flexure of the colon. The malformation must have arisen quite early in foetal life, before the end of the third month. The solution of continuity in the large intestine was in all probability caused by the snaring at the umbilical ring. The intestine could not recede into the abdomen owing to the adhesion of Meckel's diverticull1m to the amnion. The large intestine inside the hernial sac was not developed, probably because the vessels supplying it were also snared by the umbilical ring, and hence for functional purposes the small intestine ended blindly. The large intestine inside the abdominal cavity was in a better state of development than that in the hernial sac but still very contracted and empty owing to non-use. C.BSE 2.-The patient was a male infant, four days old. Shortly after birth he commenced to vomit : this persisted and became very offensive. The abdomen was distended. Nothing had been passed per anum. When seen four days after birth the abdomen was greatly distended and coils of intestine were seen in various directions in peristalsis. The rectum was normally formed. Intestinal atresia was obviously diagnosed. The abdomen was incised in the mid-line. At the lower end of the ileum the intestine ended blindlv and was continued on as an impervious cord, about half an inch in length, into a much shrunken and contracted large intestine. The obstruction was situated about two inches above the csecum. The intestine was drained and an anastomosis into the large intestine was proceeded with. The infant's condition became so grave that this had to be abandoned. A tube was tied into the lower end of the distended intestine. Death occurred a few hours later. No necropsy was obtained. At the operation I tried to pass a probe from the upper to the distal segment through the band of occlusion. This was impossible and so presumably a complete atresia was present. The structure of the band of connexion I am unable to say. Congenital atresia or stenosis of the intestine, excluding the rectum, is a relatively infrequent condition. Theremin writing in 18771 says that in 111,401 children it was observed only twice and in St. Petersburg in 150,000 children it was seen only nine times. The atresia may be found in the duodenum, the jejuno-ileum, or the large intestine. Silbermann collected 24 cases of atresia of the duodenum, and 30 cases of atresia and three of stenosis of the jejunoileum. Gärtner found in 38 cases. 20 times occlusion of the jejuno-ileum, 16 times of the duodenum, and twice in the colon. Schlegel. quoted by Braun,' collected 89 cases of atresia and stenosis of the intestine and found 29 occurred in the duodenum (32'5 per cent.), 54 in the jejuno-ileum (60' 6 per cent.), and six in the upper portion of the largeintestine (6'6 per cent.). The condition is found most frequently, therefore, in the jejuno-ileum, a little less frequently in the duodenum, whilst the large bowel, excluding the rectum, is rarely the seat of these defects. Complete atresia is more frequently observed than mere stenosis in all situations. Cordes collected 56 cases of congenital occlusion of the duodenum and added a further observation of his own. Of bbe 57 cases in 48 atresia was present and in nine merely stenosis. In 16 the infants were premature. The site of the occlusion. had a close relation to the orifice of the common bile-dnct. It was above the orifice of the duct in 20-'immediately above in 12. above but exact location not stated in eight) ; below the orifice of the duct in 13 (imnediately below in two, below but exact location not stated n 11) ; on a level with the common bile-duct in two; the ;ommon duct opened into the intermediate canal in four ; Ltresia was near the opening of the common bile-duct in one. fhe common duct was not mentioned in 15 (first portion )ccluded in three, at the junction of the duodenum and ejunum in five, six inches from the pylorus in one, the luodenum ended blindly in two, obliteration of the lower )ortion in one, complete closure of the duodenum in one, and he duodenum from the pylorus to the common duct con-'erted into a cord in one). The most frequent condition found in the jejuno-ileum is hat where there is a complete obliteration of the lumen ,nd the proximal and distal portions of the gut end blindly. 'he two blind ends may be united by a band continuous with he mesentery and in a few cases in this band a very narrow llmen has been observed; also muscular tissue and intesinal glands have been demonstrated, as in a case recorded 1