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Show TO-k MSI‘ULA IN A no. El "FULA in tire, mabove this, the rectum is diiatable and relaxed. 105 From ire tomefaction in the extremity of the gut, which suddenly sub- ritation and irregular habits of the bowels, an ulceration takes sided after going to stool, the abscess being evacuated into the rectum. No sooner has even the merest tyro introduced his finger place in the coats of the gut, immediately above the strong contraction of the sphincter muscle. An abscess at the same time, and from the same cause, forms on the outside of the gut, which soon drops down, and points by the side of the E111115$f~3 through the anus, in the complete fistula in ane, and felt the constriction of the orifice, or probed the depth of the sinus opening by the side of the anus, and found it running by the The disease, when of a local nature, is the happiest, and side of the thin coat of the rectum, than he perceives the im- offers the greatest likelihood of a perfect cure by operation. But there are diseases of the cellular membrane and skin, by possibility of laying open the diseased parts to the bottom by any other form of incision than cutting across the sphincter the side of the anus, of a very different kind. muscle, relieving this constriction, and making the sinus and With fever and restlessness, attended with a hard, full, jarring pulse, there comes a dusky, red, or purple-coloured inflammation, without much tension, or phlegmoncus hardness. lower part of the gut one surface The matter formed under the skin is small in quantity, and bad; the strength, and spirits, and pulse, sink, and the adipose membrane be comes gangrenous and sloughyt. ' 7M"T ' [WW-‘4 "mow mum ' Large quantities of matter, and deep sloughs, observes Mr. E ' . -.‘v.>p;v*:r4~‘~" Pott, are sometimes formed, and great devastation committed on the parts about the rectum, with little or no previous pain, tumour, or inflammation. The disease is sometimes connected with disease of the sa‘ erum or vertebra), and is of course out of the reach of the remedy by operation. When the disease is of the nature of the internal or blind fistula, these are the marks of its presence. When a harden- ed stool is passed with dilliculty, the feces are streaked with matter; on examining the margin of the anus, a hardness is felt, and on pressure matter passes from the extremity of the gut. When the finger is introduced into the anus, the gut is t'rlt‘to pit as it were on the diseased side, and the matter being rushed out, the membrane of the gut falls in upon the abscess. The disease has been preceded by general pain, and t I believe the state ot‘the liver should also be taken into consideration in '-_‘~‘~ ‘ 'Il‘t the formation ofthc prognosis, and perhaps in the treatment. whack ,. W‘ " " mu A, ts'icflngcr bun/Liz ' J/Lz‘: dun-s; E}, (fu'jislula; C, the probe passed first [:2de '7 (nt'fvj'i'niizf apart/if, second/y through the Sinus and flrfzn'a, and easily into 5/0," gut ; D, t/LU rectum. The patient is placed with his :‘Hfil' to the light, and then - t his mod on a low bed or made to stoop very low, noti ‘3 See l‘ott. 59%; or he may be put in thv- pi. i VOL. I. y,, c." lithetmny. |
