SURGERY. 
sitiiation of the anus, and follow his dissec- 
tiou along the sacrum in order to find the 
end of the gut, which, when found, should 
be punctured. 
Fistula in uno. Any formation of matter 
near the anus is very likely to terminate in 
this complaint ; the suppuration extends in 
the fat and cellular substance round the 
rectum, and sinuses form, having small ex- 
ternal apertures, and seldom healing with- 
out an operation. The commencement of 
the disorder may be. a phlegmonous abscess, 
attended with considerable sympathetic fe- 
ver ; or it may have a more erysipelatous 
character, spreading moi-e widely, being 
more superficial, and attended with depres- 
sion of the powers of the constitution. The 
former is seen in young, strong, and healthy 
subjects ; the latter in weakened, intempe- 
rate, and unhealthy constitutions. The parts 
in the neighbourhood ot the disease are of- 
ten affected ; and hence retention of urine, 
strangury, prolapsus and tenesmus, piles, 
&c. are produced. The complaint some- 
times begins in an induration of the skin 
near the anus without pain. This hardness 
gradually, softens and suppurates. The mat- 
ter may either point in the buttock, at a 
distance from the anus, or near this latter 
part, or in the perineum. It may escape 
,from one opening, or from several. Some- 
times there is not only an external aperture, 
but another internal one, communicating 
with the cavity of the intc.stine. 
A soft poultice and fomentations are the 
best means of treating these abscesses j 
which, if they are phlegmonous, should not 
be opened until the skin has become thin ; 
but, when they are of the ervsipelatous 
kind, should be punctured immediately to 
prevent any farther extension of the ma- 
lady. The general treatment must corres- 
pond with the nature of the constitutional 
disturbance. In all abscesses about the anus, 
the incision should comprehend ail the skin 
covering the matter, as tlie cavity is then 
most likely to fill up from the bottom. The 
dressing should be small in quantity, light, 
and unu ritating. It, however, the case passes 
into a fistula, it will be necessary to make 
it an open wound by cutting through the 
rectum, from the end of the hollow to the 
anus. A probe having been introduced at 
the external opening of the fistula, serves as 
a director for the probe-pointed knife, 
which will be felt in the rectum by the snr- 
geon’s left fore finger. If the fistula should 
not have penetrated the gut, the bistoury 
should be pushed through if.s side. The 
probe may now be withdrawn, and the 
operation completed by bringing the knife 
out with its point applied to the finger 
which was in the intestine; and tlius ail be- 
tween the edge of the knife and the amis 
must be divided. A soft piece of lint 
should now be placed in the wound, and re- 
main until it is loosened by suppuration, 
and all the future dressings should be mild 
and unirritating. The callosities of wliich 
surgeons have complained so much in these 
cases, arise from injudicious treatment, and 
particularly from the use of caustic and 
stimulating applications. 
Prolapsus ani. Tlie internal coat of the 
gut may be protruded through the sphinc- 
ter ; or a portion of the intestine with all 
its coats may descend. Causes which 
weaken the sphincter, and such as force 
the intestine downwards, contribute to this 
aft'ection. Costiveness, tenesmus kept up 
by liemorrhoids, ascaridcs, fistula in ano, 
stone, &c. are of this kind. The cause 
should be removed when that is practicable. 
The gut must be replaced, but previously 
clysters, fomentations and poultices, or 
leeches, and cold washes, are necessary. 
Horizontal posture, and avoiding costive- 
ness, are very important points. A com- 
press and bandage may he necessary to 
retain the replaced gut; and astringent 
clysters have been advised. If the pro- 
truded part has become indurated, thick- 
ened, and painful, and wilt not admit of 
reduction, it may be extirpated. Some- 
times an introsusception, commencing at 
the c*cnm, has protruded at the anus. 
This case is quite beyond the powers of 
art. 
Prolapsus, inversio, and retroversio uteri, 
are considered under the article Mid- 
wifery. 
EITIIOTOMY. 
The existence of a stone in the bladder 
causes various symptoms in the bladder it- 
self, and others in neighbouring parts. The 
former are frequent inclination to void the 
urine, which sometimes stops suddenly fl ora 
tlie stone mechanically obstructing its pas- 
sage ; pain in making water, and particu- 
larly after the discharge, from the bladder 
contracting on the foreign body; mucus, 
and sometimes blood in the urine, and pain 
on exercise. I he latter are an uneasiness 
and itching at the end of the penis, leading 
the person to draw and elongate the pre- 
puce ; sense of weight in the perineum ; 
tenesmus; numbness of the fhighs, &c. 
