80 SURGERY. 



DISEASES OF THE RECTUM. 

 FISTULA IN ANO. 



A Fistula is said to be complete when a sinus communicating 

 with the bowel, opens upon the nates ; when it does not commu- 

 nicate with the bowel, but opens externally, it is called a blind ex- 

 ternal fistula ; when it opens internally but not externally, it is 

 called a blind internal fistula. 



If complete, there is discharge of pus, fseces, and wind, and it is 

 attended with heat, uneasiness, and pain. The sinus is sometimes 

 very tortuous, and often multilocular. The internal orifice is usually 

 about an inch and a half above the anus, but sometimes higher. 

 The cause producing it may vary. It may originate in an inflam- 

 mation of the rectum, or by an abscess external to it. It is very 

 frequently connected with phthisis, caused by the constant cough in 

 that disease. 



The treatment for complete fistula is generally that of the knife, 

 the object being to place the part at rest, and convert the sinus into 

 an open sore. The bowels having been entirely emptied, the index 

 fintrer of one hand being oiled, is introduced into the rectum, and a 



Fig. 23. 



knife-pointed bistoury is introduced through the sinus into the gut, 

 so that its probe touches the finger ; thus kept in contact, both finger 

 and bistoury are withdrawn, completely laying open the sinus, and 

 dividing the sphincter ani muscle. Any bleeding vessel is to be 

 tied ; hemorrhage by oozing is to be stopped by stuffing with hnt ; 

 a small portion of lint is to be placed between the lips of the wound, 

 so as to prevent their closure ; the object being to make the whole 

 track inflame, granulate, and heal from the bottom. After the 



