about an inch and a half above the pubes 
directly into the bladder, and withdrawing 
the stileete to permit the urine to flow through 
the canula ; to the canula a cock is to be 
fitted, in order that the urinary discharge 
may afterwards not be continual, and by 
drops, but at intervals. 
When the puncture is made from the peri- 
neum, the trocar must be introduced at a 
little distance from the rapha perinei, and 
passed into the bladder, a little to the upper 
and outer side of the prostate. 
Fistula in perinxo. A sinuous ulcer in 
the perineum may be produced by wounds 
in the bladder, or neighbouring parts, or may 
arise from inflammation of these parts, com- 
mon, venereal, or cancerous. When the 
complaint is local, it is to be treated by in- 
cision in the manner of other fistulous ulcei.s, 
and dressed with emollient applications, or 
with poultices, according to the nature and 
degree of the inflammation and discharge. 
Fistula in ano. This is a sinuous ulcer in 
or near the rectum. It is called complete, 
when it has an external opening in the integu- 
ments, independant of the gut, while it <3 the 
same time communicates with the gut. W hen 
there is no actual communication ot the ulcer 
with the rectum, it is called an incomplete, fis- 
tula; and when without any external opening, 
the ulcer communicates with the gut, it is de- 
nominated occult. 
Fistulous ulcers near the rectum, may be 
produced by any local causes ot nutation , 
they frequently ioflow upon the inflammation 
produced by 'obstinate hemorrhoidal affec- 
tions. Piles, indeed, are perhaps the most 
common source of fistula in < no. These are 
to be remedied by laxatives of a bland and 
oily nature, by sitting over warm water as 
the best means of fomenting the parts ; and 
if the pain and swelling are considerable, by 
the application of leeches upon the tumour: 
such applications are principally suited to 
what are termed blind piles. When tiie dis- 
order is accompanied by a discharge of blood 
from the anus in an excessive degree, cold 
and astringent are to take place ot warm and 
emollient applications, such as solutions 01 
sugar of lead, or the simple application of 
cold water ; while costiveness, even in the 
case of bleeding piles, is to be carefully guard- 
ed against, by laxatives: chalybeates intei- 
nally will often be attended with much ad- 
vantage. The tinctura ferri muriati ot the 
London pharmacopoeia, has been given as a 
preventive of piles, with much apparent be- 
nefit. In the treatment of the complaint, 
it ought alwaysto.be examined, whether it 
acknowledges a local or a general cause, and 
whether the hemorrhoidal disposition depends 
upon debility, which is often the case, and is 
then onlv to" be combated by tonic agents. 
When an abscess has formed in or about 
the rectum, and the tumour points exter- 
nally, a free incision ought to be made into 
its most depending part, in order to discharge 
the matter as speedily as possible ; the wound 
is then to be covered with soft linen, upon 
which is spread some simple mild ointment; 
and if the surrounding parts are much inflam- 
ed, a large emollient poultice laid over the 
dressing. 
When the abscess has been permitted to 
open itself either externally or internally, and 
has degenerated into a sinuous ulcer, which 
is known by the nature ot the discharge, 
Vol. 11. 
SURGERY. 
the direction of the sinus or sinuses must he 
ascertained, by feeling with the finger in 
the anus; when their course is ascei taineu, 
a free incision is to be made along then 
whole length ; the patient is to be placed 
so that his body shall lean upon a table or 
a chair ; the surgeon is to introduce his lingei , 
oreviously oiled, into the rectum. A crooked 
probe-pointed bistoury is then to be inserted 
into the fistula, and pushed against the finger 
in the rectum ; the instrument is now brought 
downwards, the sphincter of the anus di- 
vided, and the sinus thus laid open. \\ hen 
the fistula is occult, it is necessary to make 
an artificial opening, previous to tire passing 
of the bistoury. After the sinus or sinuses 
have thus been laid open, pledgets of lint or 
soft linen spread with simple ointment, aie to 
be gently insinuated into the wound, and a 
compress of soft linen applied over the sur- 
face, and kept there by bandage. The chess- 
ings during the cure are to be often renewed, 
at least once in twenty-four hours. 
Abscess will sometimes form slowly in the 
rectum, and discharge its contents without 
any fistulous ulcers following. In these cases, 
after the discharge of the matter, much ad- 
vantage is often found in the use, for some 
time, of astringent and detergent injections, 
such as of lime-water : which the patient him- 
self, by means of a syringe contrived for the 
purpose, may with ease and safety inject 
Explanation of the Plates. 
Fig. 1. A lan :et and canula for discharging 
the contents of an abscess by 
seton 
means of a 
Fig. 2. A director for guiding the knife in 
discharging the contents of ail abscess, &c. 
Fig. 3.- A pair of forceps for extracting 
polypi , . .. 
Fig. 4. A slit probe for conducting a liga- 
ture to the root of a polypus. 
Fig. 5. A ring probe for assisting in secur- 
ing a ligature upon the root of a polypus. 
Fig. 6. A double canula for fixing a liga- 
ture upon the root of a polypus. 
Fig. 7. A bandage for making compres- 
sion after performing the operation of arteri- 
otomy at the temples. 
Fig. 8. A seton needle. 
Fig. 9. a, b, Two pins of different forms 
used in the twisted or hare-lip suture. The 
first commonly made of silver, with a move- 
able steel point ; the other of gold. 
Fig. 10. r l'he tourniquet now most gene- 
rally used. 
Fig. 11. The tenaculum used in drawing 
out the mouths of bleeding vessels for the 
purpose of securing them by ligature. . 
Fig. 12. A blunt-pointed bistoury. 
Fig. 13. A raspatory for removing the 
pericranium in the operation of the trepan. 
Fig. 14. The trephine, with all its parts 
connected and ready tor use. a, 1 he centre- 
pin, which can be raised or depressed by the 
slider b. c, The part where the saw is unit- 
ed to the handle by means of the spring d. 
Fig. 15. A brush for cleaning the teeth of 
the saw. . 
Fig. ' 6. Forceps for removing the piece ot 
bone° when nearly cut through by the tre- 
phine or the trepan. 
Fia;. 17. A levator also employed in re- 
moving the piece of bone. 
Fig. 18. A lenticular for smoothing the 
ragged edge of the perforated bone. 
753 
Fig. 19. A speculum used for keeping the 
eye-lids separated, and the eye fixed, in 
performing various operations upon that 
organ. 
Fig. 20. A flat curved hook for elevating 
the upper eye-lid, and fixing the eye, in per- 
forming various minute operations upon its 
surface. 
Fig. 21. A couching-needle. 
Fig. 22. A couching-needle for the right 
eye, fitted for the operator’s right hand. 
Fig. 23. A knife for extracting the cata- 
ract. 
Fig. 24. A flat probe for scratching the 
capsule in extracting the crystalline lens. 
Fig. 25. A flat probe or scoop for assisting, 
in removing the cataract. 
Fig. 26. A knife for extracting the cata- 
ract from the right eye. 
Fig. 27. One of Anel’s probes for remov- 
ing obstructions of the lachrymal ducts. 
Fig. 28. A syringe and pipe, (by the same) 
for injecting a liquid into the lachrymal ducts. 
Fig. 29. A crooked pipe which fits the 
syringe. 
Fig. 30. A trocar and canula for perforat- 
ing the os unguis in the operation for the fis- 
tula lachrymalis. 
Figs. 31, 32, 33. ' Instruments employed 
by Mr. Peltier in the operation for fistula 
lachrymalis. Fig. 31. a conductor for clear- 
ing the nasal duct. Fig. 32. a conical tube 
to be left in the duct. Fig. 33. a compress- 
or for fixing the tube in its place. 
Fig. 34. A trocar for making an artificial 
parotid duct. 
Fig. 35. Pins used in the operation for 
hare-lip, represented as they are. usually in- 
serted into the part. 
Fig. 36. A gum-lancet. 
Fig. 37. A trocar for perforating the an- 
trum maxillare. 
Fig. 38. Mr. Cheselden’s needle, with an 
eye near the point, for tying a knot on scir- 
rhous tonsils. 
Fig. 39. An instrument for perforating the 
lobes of the ear. 
Fig. 40. An instrument recommended by 
Mr. B. Bell for supporting the head after the 
operation for wry neck. 
Fig. 41. An instrument invented by Dr. 
Monro for fixing the canula after the opera- 
tion of bronchotomy. 
Fig. 42. A spring-truss for an inguinal or 
femoral hernia of one side only. _ ^ 
Fig. 43. A silver canula for carrying off 
pus collected in the thorax. 
Fig. 44. A spring t uss for an umbilical 
hernia. 
Fig. 45. A spring-truss for an inguinal 
or femoral hernia existing on both sides. 
Fig. 46. Mr. Andre’s trocar for evacuating 
the contents of an encysted hydrocele. 
Fig. 47. Mr. B. Bell’s trocar for operating 
in the hvdrocele. 
Ffo. 48.' A bag of resina elastica, with a 
stop-cock and short pipe, which fits the ca- 
nula of the trocars figs. 77, 78, for the pur- 
pose of injecting the cavity of the tunica 
vaginalis, in the case of hydrocele. 
Fig. 49. A straight-edged bistoury, sharp- 
pointed. 
Fig. 50. A sound used in searching for the 
stone. 
Fig. 51. A grooved staff for the operation 
of lithotomy. 
