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ing day I was surprised to find he was out. I left word for him to call at my house the next morning, which he did; I dressed the wound, it was looking very healthy, and I desired him not to neglect seeing me till he was quite well. He came to me every morning for a few days, and he made a very rapid recovery.

Fistula in ano, and urinary fistula from abscess consecutive on gonorrhoea.

A young professional friend contracted a gonorrhoea, which he treated himself by the use of strong injections: during the time he rode much, and indulged too freely in wine. The result of these indiscreet proceedings was the formation of an abscess between the urethra and bowel; he allowed it to take its own course, and the abscess burst into the rectum and urethra, and ultimately an opening formed in the perineum, through which some of the urine passed whilst micturating. He now thought it time to give up the case, and trust himself to other hands. He was confined to bed, appropriate medicines prescribed, and a strict regimen enforced after some weeks his general health was improved, the tissues intervening between the perineal opening and the one in the bowel were then divided, and the wound dressed

in the ordinary way. When it had nearly filled up by granulation, a probe, coated with nitrate of silver, was passed along the fistula to the urethra, and allowed to remain a few seconds; on the following day, pressure by means of a pad of lint and a bandage was made. In about a month after the operation the parts had healed.

Fistula in ano from an abscess not being opened.

S. R, æt. thirty-four, a groom, applied at the Blenheim Dispensary, suffering from a fistula in ano. He gave the following statement of its formation: Twelve months previously he had throbbing and heat near the fundament, and the skin became very tender if pressed; he concluded an abscess was forming, and had recourse to poultices, but several weeks elapsed before it burst: passing a stool gave him great pain; shortly after this he observed the fæces streaked with pus. He had continued the use of poultices, hoping the part would heal; he had also used various ointments and lotions that had been recommended to him, but without reaping any benefit from them.

On making an examination I perceived a small opening in the integument surrounded by fungous granulations, situated an inch and a half from the anus; a probe passed readily from it into the bowel, and was felt about three-quarters of an inch above the margin of the anus by the finger, which had previously been introduced. His general health was good, and the case appeared one that might be healed without incision; but as he was most desirous to be cured as quickly as possible, I determined to divide the parts, which I did on the following day, having previously prescribed medicines to unload the bowels. In less than a fortnight the wound had quite healed.

Fistula in ano; several external openings and extensive sinuses.

H. E, æt. forty-one, a butler, came under my care suffering from fistula. He attributed its origin to injury of the bowel by a bone that he had swallowed, which he said lacerated his inside on its passage outward, and gave rise to an abscess by the side of the fundament; he applied poultices, and it burst in six or eight days from the time he first felt pain. He continued to poultice the part, and he was in hopes it had healed, but matter again formed, and then discharged itself. This process recurred several times, and other openings formed towards the buttock. During this time he had taken various medicines, and used lotions and ointments: one gentleman whom he consulted proposed an operation, but his occupation prevented him lying up. At length, his general health failing, he was compelled to submit himself to proper treatment. When I first saw him his countenance was sallow; the sclerotic conjunctivæ yellow; his tongue was much furred and deeply notched transversely; his pulse was soft and weak; and he had been of constipated habit for years. The integument on the left side of the anus was of a purplish-red colour, and the subcutaneous cellular tissue was infiltrated and indurated; four fistulous openings existed, one was within an inch of the anus, the furthest was five inches from it; a probe directed through the nearest opening to the anus passed a considerable distance up by the bowel; by a careful exploration an internal opening was found threequarters of an inch above the external sphincter. He was confined to his bed, and mild mercurials, taraxacum, and

purgatives were prescribed: when the bowels had been thoroughly cleared out, and his countenance had assumed a brighter aspect, he took the iodide of potassium and sarsaparilla. Under this treatment the integument of the anal region became more healthy and the induration considerably diminished, but its vitality was too low to offer a hope of the healing process occurring without dividing the sinuses; I therefore laid them freely open, and also divided the tissues between the opening in the bowel and the external one. Two or three ounces of blood flowed, but no vessel required ligature. The wounds were dressed in the manner that has been directed; and, after the third day, the bowels were kept open by laxatives and enemata, and great attention to cleanliness observed. He continued the iodide of potassium and sarsaparilla for three or four weeks after the operation, when the iodide of iron was substituted for it.

In consequence of the condition of the tissues, and the length of time the disease had existed, it was nearly six weeks before the wounds had entirely healed.

CHAPTER XIV.

POLYPI OF THE RECTUM.

LIKE the mucous cavities of the nose, uterus, and vagina, the rectum is occasionally affected with growths of the nature of polypi. They vary in structure and form, and may partake of the character of the mucous polypus, the sarcomatous species, or the malignant. Sir Astley Cooper* describes those observed by him as resembling a worm or leech in form, vascular, and of a deep-red colour. Dr. Bushe† thinks the mucous species the most common. Mr. Symet says the disease presents itself in three different forms; the first being similar to those described by Sir Astley Cooper; in the second the growth is soft, vascular, prone to bleed, lobulated, or shreddy and malignant looking, but possessing

*

The Lectures of Sir A. Cooper, Bart., on the Principles and Practice of Surgery,' edited by J. Tyrrell, vol. ii., p. 357.

p. 227.

A Treatise on the Rectum and Anus,' New York, 1837,

On Diseases of the Rectum,' by J. Syme, Third Edition, Edinburgh, 1854, pp. 103-105.

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