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Show 106 . I‘lS'l'UI..\ 15‘ AND., risIULA In no. We have, in the first. place, to examine the course and ex" tent. of the sinus, by introducing the probe bent, so as to pursue every labyrinth, should extensive sinuses occur. The operation should be deferred, it there is much irritation and inflammation, and the patient in the mean time he made cool and easy, by repose, mild laxatives, and cataplasrns We HGT-""7 , * 4‘19"" ll 7 mum d 10‘ meats than the probe-pointed history, the probe, and the din rectory. If, however, the fistula he very deep, and the coats of the intestine be deeper than we can reach, it will be safer to use the wire as is described below. Sometimes the fistula in arm is by no means so simple as I or fonientations to the parts. Having; made ourselves so far acquainted with the sinus: or abscess, with a little oil on the fore finger of the disengaged have described it ; but, on the contrary, besides the sinus com: munieating with the gut, there run callous fistula in the perineum, and towards the hips. These we should endeavour to lay open, and cut. (AT the anghn which are formed in the hand we introduce it into the gut. skin by the incisions. Now, by moving the When they penetrate and run deep, point of the probe over that surface of the abscess next to the gut, it is felt by the finger, and will be made to slip into the comnumication betwixt the gut and cavity of the abscess. their surface, rousing them to activity; after which we have to endeavour to promote food suppuration and the rising or "'e have now to examine whether the disease does not extend granulatious from the bottom. their mouths must. he searilied so as to produce an action on further up by the side of the gut than this hole of connnuni But there is a more dcplorabic case in which the surgeon cations/5". The operation is exceedingly simple in these Cil'f‘tllllf‘ti‘tllCt‘s. A directory is introduced instead of the probe, from the. es}, ternal orifice through the sinus, until it enters the gut. Along: this the probe-pointed history is passed, until the point. rest: upon the finger, when the directory is withdrawn. 'l‘he tint grr in the rectum, with the history, thus pressed against it, is should take heed, lest he promise what his art cannot accomplish, for, sometimes the lumbar abscess, instead of making its way along the cellular membrane under the peritoneum, and pointing at the top of the thigh, descends by the side of the rectum, and appears here in the hip. This is, however, happily, a rare occurrence. When the disease is of the nature of the internal fistula, it is made complete by thrustinlr the abscess lancet into the hard margin of the anus, the hardness indicating the neighbourhood of the sinus. But it will be better, after ascertaining the nature of the disease, to endeavour to find the opening of the gut, which in this case being the sole Opening, is generally withdrawn, and the intervening part betwixt the gut and ii nus, is thus cut through. In introducing the knife, there is no necessity that the dime: tory should he previously introduced, for with the point. of the history groping against the linger in the gut, the communica tion may he found; and even this conununication is of little consequence it we are sure that we lay open the gut to that free. "'0 may do this by introducing the probe, with about. point, and make our incision extend as far as there is felt a thin an inch or more of its extremity, bent almost entirely hack on itself. The probe is carried flat upon the fore Linger ~, and membrane, only betwixt the probe and the finger. 1n thh operation 1 cannot conceive a necessity for any other instru~ communication, the (and of the probe drops into it, and then where the finger feels the inequality or hard margin of the the probe being: drawn, the point appears by the side of the- 9" w ' Pm ~'lOJS v to the ope] uJUOD, ' , the bowels should be emptied and brought to an easy state, and the rectum cleared by a clvster. The patient is placed stooping, with his elbows resting on a chair : 012i)- .‘mg on his back on a table, with his but: (irks raised on a pillow, and his leg? hi id asunder anus; or, with the knife, we can out upon it. Then the part :4 being in the state of the perfect fistula, the operation is (301" pleted by the probt-pointed history being made to follow the probe, and by laying: the gut and sinus int 0 one entity. |