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of many final] turkeys tumble out of center of which matter Is formed1, and
him. the nvddle of which become* red.
Her husoind, who is one of our This diseaseisgenerally called a phlejr
magistrates, fays, that the widow mon, and with all its painful fyrapte
Block, near UeviCastle upon Delaware, vanishes as soon as the matter is difhearing her turkeys disturbed, spied ^ charged, which, though plentiful, is a rattle-snake at the foot of a cherry- good. At other times the external tree, looking at them. She got a parts, after much pain, fever, and fence rail and threw one end of it up- sickness, become inflamed, without em the snake, which made him bite hardness, and the skin acquires am ethe tree, and the tree soon died. rysepalatous appearance; in this cafe One WUuam VtfitA, (whose wife lost the disease is ftipeificial, the quantity her life by the bite of a rattle-snake) of matter small, and the cellular anecnfind'mg one close to a young chesnut- B brane doughy to a considerable extree, which sprang from a stomp, de- tent.
layed not to strike tbe snake revenge- Sometimes what the French ca'l a
fully, upon which, with a great rage, gangrenous suppuration is formed, in
it bit the tree and killed it immedi- which the cellular and adipose tnem
ately. J. B. branet are affected as in a carbuncle.
This case is an indication of a bad
Jin Account of si* Fistula in Anx>,fron habit, which it uneceuary to correct Mr Pott"* Remarks jafl published. fj b^ medicine.
(Stt f. 484.; But in all these affections the whole
jk True Fistula is a deep, hollow malady is often confined to thejfieia,
j\ ulcer, with callosities, and a and cellular membrane underneath.
imall outlet, by which it discharges a Sometimes, however, many complaints
thin acrid sanies. arise from the influence of the parts
Very few of the disorders of the immediately affected on other parts
fundament, that ate called by this that lie near them, producing retenname, and'treated with all the feve- "tion of urine, strangury, oVifury, bear
rrry that the true Fistula is supposed ing down, tenesmus, piles, diarriiæi,
to require, are so, and the trite Fistula or obstinate colt ivenels, complaint* ft>
itself is generally Treated with great- pressing as to require a particular at
er severity than is necessary." tension._
The far greater patt of the diseases Sometimes large quantities of roatcalled Kirtulas, have not, at first, any ter, and deep sloughs are formed, so one character or mark of a true fit- 8 that great devastation is committed on tula, nor can, without the most supine the parts about the rectum, with Utneglect of the patient, or the molt ig- tie or no pievioas pain or inflammanorantmismanagement of the surge- tion.
on, degenerate, or be converted into Sometimes rite disease first appears
one. by an induration of the skin near the
In iropostumations near the anus, verge of the anus, without pain or there are frequently such openings, « change of colour, which hardness gra
yielding such a kind of discharge as dually softens and suppurates, and
in a Fistula, and they are also attended the fore being superficial and clean, is
with indurations; yet such indura- soon well.
tions are merely a diseased alteration. But it sometimes happens, that the"
made in the structure of the parts, and the pain and inflammation is slight,
are so far from being callosities, which yet the quantity of matter is large,
it is necessary to remove by cutting and its quality bad, extreamly offeniristruments, or to destroy by caustics, va five, and proceeding from a deep and
that they may be easily cured. crude-cavity of a bad aspect.
The disorders Ignoiantly compre- The place where the abscess points,
hended under the common name of and would break if let alone, is also
Fistula are various. various; sometimes remote from the
Sometimes the attack is made with anus, sometimes neat it, or in the pe
gmptoms of high inflammation, pain, rineirm. Sometimes it breaks in ope ver and rigor, and the abscesrproves _. place, sometimes in more; sometime*
truly critical, and is tbe solution of there is one opening through the skin
the fever. externally, and toinrtimes another
In this case, the buttock near the through the intestine into its cavity.
Amis is considerably swelled, and has Sometimes the rectum U not as
a lame circumscribed hardness, in the fected bv the formation of the matter.
Account of tbe Fistula in Ano. rjc
sometime! It it laid bare, and some- merit mult be lost; the part affected
.times it i» perforated. must be frequently fomented with not
The original feat of the mischief is spirited fomentations, a large and deep
sometimes very high up in the pelvis, incision should be made, and applies
and the parts that furnish tbe matter tions made of the warmest and most
being oat of reach, the cafe is hope- A antiseptic kind. This disease it call
left from the first. Yet these dis- ed a carbuncle,
charges are sometimes salutary, and The symptomatic strangury, and
prove solutions of general diseases, but dysury, are commonly relieved by
they often prove fatal by exhausting bleeding, with the uses of gum ara
Aelaft remains of strength. "bic and nitre.
If the disease has its foundation in To remove the total suppression it
the Anv vtHerta, which is not uncom- has been almost the universal practice
mon.it frequently communicates with ** to use the catheter; but this is eslen
the urethra, and neck of the bladder, tially wrong, and frequently produces
and somettmes it happens that fistulous the most dreadful consequences.
openings near the anus, give dis- tu this c.ife, the suppression o* urine
charge to a sanies proceeding from a arises principally from Irritation, and
cancerous state of some of the parts the disease is spasmodic ; but, suppos
witttin the pelvis. ing it to be inflammatory, whatever
Thesevariouscircumftances require Q irritates must be wrong; the intro.
various treatment. doctionofthe catheter never fails to
When no symptoms require parti- irritate, whether it is withdrawn or
cular attention, all that the surgeon left in; and the resistance made by
has to do is, to assist the maturation of the parts in this stare is so great that
the tumonr, and a soft poultice is the if any violence is used, the instrument
best application. will make a new way for its passage
When the disease is of the phlegmo- in the neighbouring parts, and pro■noid kind, the thinner the (kin is suf- D duce irremediable mischief, fered to become before the abeess is The only way safely and effectually opened, the better: The patient be- to relieve this symptom, is by evacuaing generally of a full ana sanguine tion and anodyne relaxation, habit, if the pain be great, and the se- Loss of blood is necessary, accordver high, may bear evacuation both ing to the strength of the patient; by phlebotomy and cathartics. the intestines must be emptied, if time
When the disease is of the eryfipe- E permits, by a gentle cathartic; re
httous kind, the patient is generally course must be had to a warm bath or
bilious, and will not bear evacuation. semicupium, or bladders of warm wa
This should be particularly noted, for ter mutt be applied to the pubes and
evacuations in this case, notwithftand- perineum; but above all glysters of
ing the indications of quick pulse, and warm water, oil, and opium must be
heat of the flein, frequently prove sa- injected. "There may have been
tal. p " cases, fays Mr Poll, that have baf
Tn inflammations of this kind the "fled this method of treatment, but I
disease is rather a sloughy putrid state "never met with one of them."
of the cellular membrane than an im- For the removal of the tenesinus,
poftbumation, and, therefore, the give a dose of rhubarb with a warm
sooner it is opened the better 5 for the anodyne, such as Constfl. Mithrid. if
matter will sometimes never make a that does not succeed, the injection
point, though the abscess will greatly p ofthin starch and opium, or Tinff.Tbe.
increase.' baic. is almost infallible.
When,instead of the preceding ap- The bearingdown is relieved by the
pearances, the skin is of a dusky pur- fame method.
plifh red colour, feels doughy and un- Obstinate costiveness, with the piles
resisting to the touch, and has little are relieved by phlebotomy, laxative
sensibility; and when the pulse at the glysters, and a low cool regimen,
fame time is unequal and falrring; When the matter of tbe tumour i*
with irregular fhiverings, a great fail- discharged by nature or is to he dis
ure of strength and spirits, and an in- H charged by art, the disease may be re
'lination to dose, the cafe is formida- duced to two heads:
ble, and the event generally fatal._ 1st, That in which the intestine it
In these circumstances the habit is not interested,
always bad, and generally from glut- id, That in which it is either lj;J
tony and drunkenness. Kin a mo- bate, or perforates*
If the tumour is ripe and not brok- oprned.than delayed.; for it will cause; en, it should always be opened with no perceptible encreasc of pain, not • knife, never with a caustic, except lengthening of the operation. when the destruction of glandulous In this cafe, the intestine must be parts is necessary, which very seldom divided from the verge of the anus to happens. the top of the hollow, in which the The knife mould be passed in deep /^ matter was formed, that by producenough to reach the fluid, and the in- ing an open instead of a sinus fore, the cilion continued upward and down- cure may be firm and lasting, ward so as to divide all the (kin that The best instrument for this purcovers the matter, pose, it the curved probe pointedThe cavity will often be found at a knife with a narrow blade which should distance from the gut, and then it never, if possible, be out of the fight must be considered as a mere abscess or the direction of the finger of the in the cellular membrane, and digest- B oper-irnr. SJssars, which always pinch edincarned, and healed without med- before they cut, should never be used. tiling with the gut. In using the knife, the operator This, however, is frequently at- should pars his fore-finger into the tempted in a very preposterous man- intestine, and introducing bis knife ner. into the sinus, pierce the gut, and reA notion has been generally re- ceiving the point on his finger conreived, that the hollow is caused by a C duct it along till all that is between loss of substance, and the hardness by the edge of the instrument and the a diseased alteration in the structure verge of the anus is divided, of the parts; in consequence of which This is the only operation, which, the cavity is filled, and diltended to in the circumstances now under conprevent the renewal of the flefli too fideration, can ever be necessary, hastily, and the dressings with which Immediately after the operation, a it is so filled, are general el'charoiic soft dossil of fine lint should be intrawith a view to dissolve the hardness: D duced through the rectum, between the Whereas the truth is. that the ca- divided lips of the incision, as well to vity 13 the mere effect of the fepera- repress any slight haemorrhage, as to tion of its sides, and the induration preveat the immediate re-union of the nothing more than the necessary con- parts divided, and the reft of the sore sequence of every inflammation of lhould be lightly dressed with the fame membranous parts, tending to sup-, application. This dressing should nat puration. p be changed till a beginning suppuraThe dressings, therefore, ought not tion renders it loose enough to come to be such as by their quantity distend, easily away; and all future dressings and by their quality irritate and de- should be as light, soft, and easy as ttroy, hut such as will lie light and possible; use no eseharotic, tho' the easy, such as will appease, relax, and sides be hard, the incision inflamed, /often. and the discharge be for some days It is indeed true, that when by this discoloured and gleety. The induratreatment, a large hollow is convert- F tion and discharge are not signs of died into a small sinus, the sinus will Ceased callosity, and undiscovered sinot always perfectly close and heal; nusses, as too frequently has been but it is also true that the patient has imagined; and applications made by a better chante this way than the o- which the hardness has been encrcalther, without any of the misery which ed, and new sinusses formed, the other produces. When a discharge of the matter by If the habit is good, the sore will _ incision has been too long delayed, it heal; if bad, the wtiole farrago of ex- bursts its way out somewhere near the ternals will be applied to no purpose, fundament, ot into the coats of the But it some times happens, that intestine, or both; but neither of though the intestine is not pierced, it these cases are siltulous; they are i? so dripped, or laid bare, that no mere abscesses whether the distuaigejs consolidation of the sinus can he ob- by one aperture or more, and require tained, but by laying the cavity of „ no such treatment as a Fistula may the abscess and that of the intestine possibly require, into one. Whether there be an opening in tht When this appears manifestly to be skin only, oranother in the intestine, she cnle, the cavities had let er be may be known by introducing a laid into one when the absciss is suit probe into the sinus, by that orifice
Account of the Fistula in Ano. 51 f
in the (kin, and passing the fore-fin- stools are smeared with matter, and a
ger up the rectum. dull pain continues, j0 external open
This natural opening being seldom ing mult be made, and matters being
sufficient for a cure in this cafe, the then in the fame state at when an o
incision mould be exactly the fame as pening was made by the burl!ing cf
when the intestine is only lai.l bare: the tumour, the method of cure, mult And, I do not, fays Mr Poll, recollect A a''° he the fame,
a single inltance in which it has fail- The true Fistula, a deep hollow fore
«d to produce a cure, if the cafe were or sinus, all parts of which are so
curable by any means ; the operation hardened as to be incapable of being
by caustic and ligature, are painful, healed in that state, and from which a
and pernicious in the highest degree.' daily discharge is made of a thin dif
Many surgeons of great eminence coloured fames, ot fluid, is of two
have recommended the cutting away kinds.
both part of the intestine, and of the" The first is the effect of neglect, ikin composing the verge of the anus, distempered habit, or bad manageneither of which at all contributes to ment.
the cure in this cafe, but both are at- .The second, is the consequence of tended with excrutiation pain & lasting disorders whose origin and feat is not inconvenience; sometimes the extir- the immediate sinus or Fistula, but pation of the whole verge of the anus more distant parts, is directed, yet after such amputation c The first is a local disorder j the settle patient will neither be able to re- cond hi not. The first it generally tain a loose stool, nor expel a hard cureable, the latter generally incure* one. Some small part of the process able.
may be necessary in the true old cal- In all cafes that were originally
lous fistulous fore, which is not the mere collections of matter within the
cafe, one time in a thousand when the coats of the rectum, or in the cellular
disease is stigmatized with the name, member which surrounds it, and
and treated accordingly. ** which, by long neglect, gross misma
This extirpation of part of the gut, nagement, previous disoideis which
and part, or all of the verge of the affict the whole habit, and for which,
anus, is, what is called cutting for proper remedies have not been taker,
the Fistula, an operation greatly to become truly fistulous, relief is not
be dreaded indeed, but seldom or ne- first to be fought from surgery 5 the
ver necessary. diseases of the habit are first to be cor
When the matter of the tumour ha« g rected j if the patient is tainted with
escaped, by more openings than one, the/*// <aenerta, that must first be cur
the cafe is much the fame as when it ed 5 if he be anasarcous, or leuco
has escaped by one only ; such open- phlematic, these must be corrected j
ingsdo not lead to distinct sinussrs, a* if he be feverish, the heat must be
the patient is apt to fear, and the un- calmed, and if he labour under the
skilful practitioner to believe, even general ill effects of a foul skin, dirty
though the cavity appears large, and cloathing, unclean and unwholesome
theprobe, if pushed with any degree TM lodging, producing palled counte
of force, passes in more than one di- nance, loss of appetite, œdamatous
rection into the cellular membrane j legs, and intermitting fever, the state
and nothing more is necessary, than to ot the blood must be amended before
divide each of these orifices, so as to surgery can be administered to any
make one cavity of the whole j this good purpose. On the contraty, when
the probe-knife will easily and expe- the lues is cured, when the patient it ditiousty do, and if the edges of the Q cool, and gets good sleep, when the
sore should then be very ragged, the secretion of urine is so established, the
removal of a small portion of the irre- general absorbent faculty so restored,
gularities will answer all the purposes and the solids so braced that the legs
of cure, and produce a smooth even cease to swell, and the patient reco
cicatiix aster the sore shall be healed. vers his appetite and complexion, the
When the matter instead of mak- local disease will have made great ading its way through the skin, pierces Jj vances towards a cure in the mean
the intestine only, the cure will ge- time, and what chirurgical operation
nerally be spontaneous; the matter or treatment may be necessary will
being discharged ; the tumour will succeed immediately,
subside and the patient become easy. The surgery required in these cases
But if any hardness remains, it* the consists in laying open and dividing
(Cent. Mag. Nov, 1765.) the
tie sinus or fituisses, so at to prevent sometimes formed in the cavity, or i
the lodgment ot matter, and lay tliem the neighbourhood of the rectum an
into the rectum; if the internal parrs fundament, where they make drtad
of the hollows are hard, they mult he ful havock, hut "as I do not know,
lightly scratched cr scarified with the "says, Mr I oil. what will cure a canv
pjiiJt of a knife or lancet, and if front "cer, I leave the discussion of thesis
the multitude of orifices, or the loose "cafes to those who say they do, moii flabby hardened or inverted Hate of A •« sincerely wishing that it was in nay
the bpi, and edges of the wound near "power to fay 1 had once in my life
the fundament, it appears improba- V known them to hare fulfilled their
ble that they can be brought to heal "n. omil'e."
smooth and even, such portion of Fistulous fores, unusfes, and ir.duthem should be cut off, as may just rations about the anus, which are serve that purpose. The dressings consequences of diseases about the should be suit, easy, and light, and B neck of the bladder and urethra, callsuch only as tend to soften the parts ed Fistula: in Perineo, require fepaand savour their heating, if a loose rate and particular consideration. In fungous flesh, hat taken possession of these the external openings are the the insie'e of the sinus, (a thing much least part of the complaint; the flrictalked of, hjt seldom found) a (light turein the urethra, the induration of touch of the lunar cauttjc will reduce the whole neck of the bladder; thp It sooner and better than any other Q hardened, fungous, inlarged, or ulcfcharotic. cerated slate of the prostrate gland;
The method and medicines by the diseases of the vtrumonianam, of
which the habit was corrected, must the veficulastminalei, and vetfa destrem
be continued through the cafe i and tia, are the great and principal ob
all irregularities carefully avoided. jects of consideration, and to a more
By these means, case's at first for mi- serious consideration than they have dable have been brought into such a Q hitherto met with, they are recomftate as to jive very litl le trouble in mended by Mr Pott, with an ardour of healing, and the patient has done humanity that does him great howell without any of those operations nour, and an intimation that he will so justly dreaded, and so generally himself treat of them at another optaught and practised.' port unity, which cannot fail of giving
It the bad state of the sore arises great pleasure to the public from its having been crammed, irritated and eroded by the introduction An Account os the Trial of Catherine of tents eoihued with escharotics, or" JS'airne and Patrick Pgilvy, for Inky the injection of aflrinpent liquors, cefi and Murder. one under a notion of destroying cal- . sip H E prisoners were indicted of losities, and the other for drying up 1 incest and murder in one inthe gleet, no operation should be at- dictment, upon which a point of law tempted till the parts are easy cool has arisen (Sees. 449. See also ajbort and quiet, whuh may be effected by p narrative, p. 376-) cataplasms, glysters, rest, arid proper The deceased was the eldest of three medicines, and then the process must brothers being about the age of forty, be the fame as hat been already di- and Laird of East Miln in the county retted. of lorsar \ the prisoner _ Patrick was
But collections of diseased fluids are the second, who was a lieutenant in
sometimes formed, about the lumtal the »v,rh regiment ol foot, juit rctuih•vettelr*, under thePsoas muicle, and p ed from the East btdiet\ the third was
near the*/ saenm, which form sinus- Akxander, a doctor of physic. The
les that run down by the side of the prisoner Natrne was about twenty
itictum. and burst nearthe fundament. years old, and daughter of the
The discharge in these cafes is gene- late Sir Thomas Nairne of Dwi/inatif,
rally foetid thin and sharp, and the Baronet.
fSnutsrs with the orirjee* become truly Ot the incest there is no direct evi
sistulous. rlence, but there is circumstantial evi
Iu1 Liiese cases.it is manifest, surgery' dence of the strongest kind by several can do little ^ood, as neither initru- " witnesses, whole testimonies mutually
merits nor applications can reach tjie coincide with, and gieaily confirm
feat of the disease. If the patient is and strengthen each other,
irtliesed, it mail be by medicine, or -. When the two prisoners were in tjie
£»'uri. "' deceased's house during his absence,
Cancers and cancerous sores are also ••»."•« *•••"• • they