OCR Text |
Show 103 FISTULA IN no. EIS'IULA 13: Also. If in our examination of the fistula, the intestine feels bare, and the probe is felt distinctly upon the finger, we may thrust the probe through the gut, and proceed as if there had been a communication. Circumstances may occur, as where the pa tient absolutely refuses to be cut, to oblige us to operate by the ligature or leadcn wire. The lead wire is introduced in this way: a small silver canula, with a gentle curve towards the end, is introduced into the fistula, and then the linger being in the rectum, we feel for the communication, and introduce the canula into it. An assistant now introduces a considerable length of the wire through the canola, which bring; felt at the further extremity by the finger in the rectum, it is talien hold of by bending the first joint of the finger, and brought out by the anus. The canula is now withdrawn. He then place a small compress betwixt the anus and the opening of the fistula, and twist the i" Two 4J3WV ll [74,»: "WM ends of the \\ ire over it. By drawing,~ it tighter from day to day, it makes its way out by ulceration, and the cure is nearly accomplished by the time the wire has cut itself out. i In women there Menu: a wry seVere complaint of the nitture of fistula in awe, via. a communication formed betwixt the rectum and the vagina. This is a disease which probably proceeds from some foreign body lodging in the rectum, or from some injury received in labour. After this has been examined, and all source of irritation removed, for bones and shells have been known to occasion it, I would imagine, that by slight scarification and dressing, it shouid heal; or, p '11 haps only by la: 'ng open the rectum up to the iistulo us com« munication without laying the rectum and vagina into one; or we pass seton from the rectum into the vagina, which pre: vents the lodgement of matter, and stimulates the sore to heal. I adopt the following method of operating from a case not der Mr. Lynn‘s care, in which the old metho d of operating for 31st ula in one v. 9.2:. had recourse to: take a leaden probe, of the term of the con‘n‘non eyed siiver probe, and putting into it a, '«zrong and \‘t't‘ll waxed ligature, introduce it into the rectum; t of the instru- 109 ment through the communication. Now the probe must be bent and brought out by the vagina, so as to draw the ligature through. Taking now the ends of the ligature, (the one hang» ing from the vagina, and the other in the rectum) throw a surgeon's knot upon them, and place a piece of lint in form of a compress, so as to press upon the perineum and to be includm ed in the ligature. By drawing this knot occasionally in the course of a few days, the gut and vagina are cut through, whilst both the ulcer and the out fill up as the ligature advances: the com= press against the skin makes it. the last part of being cut throu gh. As in the fistula of the urethra, all the collosities in the skin about the anus will go away w hen the fistula, the occasion of them, is cured. The liner albus, a mucous orichorous discharge from the Vagina, is the most common female complaint. I mention it. here as connected with other complaints, as to be distinguished from purulent discharge. With it, there is severer pains in the back and loins-a failure of strength-a pale yellow countenance. When it is copious, offensive, and acrimonious, the orifice of the womb is probably affected. When the matter flows at intervals-when it appears to burst forth, and again to subside, CSpecially if distinctly purulent, there is some ab: seess probably connected with the vagina, or on the inside the labium, and the parts should be examined. If there be an abscess connected with the external parts, it ought to be laid. open freely, and more active inflammation produced by fiilllllk tating dressings. But there is an inflammation and abscess which forms in the labium an acute disease, and very painful. Here we have only to assuage the pain and inflammation, which brings the suppuration kindly forward. I have found able practition» ers averse to opening :i.bs:cer='s*-*--there is rarely, I fulfil 7m." |