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Show 102 I‘ls'l'ULA IN ANO- rIsTULA IN AXU. should not be secure against harmorrhagy, if the patient goes to stool before the parts are consolidated by inflammation. He bleeds from the extremities of the veins during the effort at stool ; and Mr. Hey had to take up with the needle two arteries on the side of the anus, an hour after the operation, in consequence of hannorrhagy ; and the application of the liga: ture was attended with considerable difficulty. The ligature is the better way of exciting the inflammation necessary, and the safest and least inconvenient method. external skin. This is the perfect state of the disease, if I may use such an expression ; but there are many varieties. Very often abscesses are formed by the side of the anus, which have yet no communication with the rectum; and when the probe does not pass up by the side of the gut, when the finger in ano does not discover the bareness of the coats of the gut by the rubbing of the probe in the abscess, it will be sufficient to lay it freely open, and to use light dressing, and keep the bowels open and the health good. There 103 will be no necessity for cutting the gut, or considering the 0F l'lSTULA IN AND. disease in any other light than as a common abscess. Yet we must confess that, even in the case which has no connexion with A I‘IS'IL‘LA! in ano is a deep impostluunation by the side of the anus. When the matter makes its way through the skin, surgeons have called it an External Fistula; when it has opened into the rectum, it has got the name of Internal 01' ‘wduw lf'thA ..3.,~u-‘:-4-e~'- .,. ' fill Blind Fistula; and those abscesses which have an opening in the surface, and also communicate internally with the gut, have been termed Complete Fistula. Often there arise large phlcgmonous boils by the side of the anus, which require to be brought forward and opened early. Sometimes a hardness and pain on passing the excrcnn‘nts give sign of disease, which suppurating, gradually softens and bursts,- discharging good lllilitCI‘. This may have no connexion with the gut, be super», ficial, and healthy (as an abscess), and consequently require no operation. In the cellular membrane by the side of the gut, there is; an abscess formed, with callous secreting walls. This abscess opens by a small aperture, externally round, hard, and but lit» tlc inflamed, appearing almost like the opening of a natura l duct. Through this opening, matter and feces are dischar g‘~ the gut, though when the matter is discharged the external swelling subsides, and the orifice becomes clean and healthy like~yet it does not close, the matter has to be pressed out, the disease remains offensive and troublesome, and discharges a thin acrid fluid-we have to treat it as a complete fistula. Abscess of a very bad kind is peculiarly apt to form by the side of the anus, in consumptive people. If the physician gives up his patient into the surgeon's hands, to be cured for fistula, when there is a phthi: cal cough, the latter may 63% pect little reputation to result from his practice. Often in reduced or originally bad constitutions, the sore is not of a fistulous form; there is an irregular opening, with. loose flabby skin, covering a pale smooth flesh, accompanied neither by inflammation nor discharge. In this case, when the parts are freely cut, they should be dressed with balsamic and stimulating applications. The origin of this disease may be primarily in the cellular membrane, by the side of the anus, and the sinus works its Way by the Sit e of the gut. It may run forward into the ed; and upon examination the side of the fistula or sinus is perineum, or connect itself with the urethra. found to have an opening into the gut similar to that in 1110 inflammatory state of these sinuses, there not unfrequentl y arists a difficulty of passing the urine, until the parts have re had descended on going to steel, is reduced ; more rarely there is an cnfirr ( irele. Mr. Hey speaks ofthe gut desce nding, an d adhering to the intcié'" ments by the side of the anus. This lean imagine to be onlv the Willi"? of the root ofthe tumour to the margin of'the mus. In the first and solved into suppuration, and the matter is evacuated. In general, the disease arises from an irritation in the gut. The. il'him'if‘i‘ muscle 0f the extremity of the recf :sz is very strong |