72 



SURGERY. 



together by the continuous suture. The subsequent treatment 

 should consist of perfect rest, and the prevention of inflammation ; 

 venesection and leeches, and large doses of opium, will probably 

 be necessary ; nothing but thin arrow-root, or mucilage, should be 

 given as a diet, and it may be necessary to administer this by the 

 rectum ; purgatives should be studiously avoided. 



ARTIFICIAL ANUS. 



This is an unnatural opening of the intestine, through which fseces 

 are discharged. It may be the result of a wound, or sloughing con- 

 sequent on strangulated hernia. The orifices of the upper and 

 lower portion of the intestine are united with the abdominal wall. 

 The lower portion of the bowel becomes contracted, and receives but 

 little faeces. The integuments around the artificial opening form a 

 funnel-shaped cavity, the edges of which are red, everted, and exco- 

 riated. The consequences of the affection may be inanition by the 

 escape of chyle, especially if the upper portion of the small intes- 

 tine be engaged ; a patient is liable to hernia, colic, besides the dis- 

 gusting annoyance of the constant escape of fseces and flatus. 



The treatment will consist of regulating the bowels by diet and 

 medicine, and by supporting the orifice by a compress or truss, 

 which will retard the escape of the discharge, and promote the con- 

 traction and cicatrization of the funnel-shaped cavity. It may be 

 necessary to perform Physick's operation : this consists of introducing 

 a ligature by means of a curved needle into the orifice of the upper 

 intestine, and bringing it out through the orifice of the lower, which 

 ligature is then to be secured with a slip-knot. The object of this 

 ligature is to produce adhesion between the peritoneal surfaces of the 

 upper and lower intestine: this will require several weeks; after- 

 wards, an opening is to be formed through this adhesion by means 

 of a bistoury, through which the fseces will pass from the upper to the 

 lower intestine, the external orifice being firmly compressed with a 

 truss. Dupuytren operated by means of a forceps, one blade of 

 which was inserted into the orifice of each intestine, and the pressure 

 regulated by a screw at the handle. The effect of the pressure of 

 the two blades of the forceps, is first to produce adhesion between 

 the sides of the two intestines, and by still greater pressure, to form 

 an opening between them by ulceration. 



HERNIA. 



Hernia signifies a protrusion, but the term is usually limited to the 

 protrusion of the abdominal viscera. The predisjwsin g cause is a 

 weakness of the pariefes of the abdomen at the natural openings. 

 This weakness may be increased by injury, disease, or pregnancy, 

 and there may also exist a congenital deficiency. 



The exciting causes are muscular exertion, jumping, straining, 

 playing on wind instruments, coughing, vomiting, lifting weights, 



