1000000031

·be kno\V" oy a

difchar~

of maner from the

nntll.

' 'Vhcn

this is the fhl1e

the fiflula, tht:re is no hcfitation

-made 'j bU[ immediately puttiog ene bl.lde of the

fcifT.H5

the s ut, ?nd lhe o:h:!r up lhe wound, fr,ip the

\Vhole ¡cngtn

it.

Thi~

procefs is as advifclble when lhe

intdline

ís

·nOl

perfurated,

lhe

jinta

is narrow,

and

runs upon or

Yery ncar

it:

forif lhe abrecfs be

teored,

",hich is lhe ooly

-way of drc-ffinr.

while lhe external orifice is fm aJl,

will

almol1 certainly grow

callolls;

(o that tbe

Curen

means of

cure,

\ViII

opeDing

lhe gut, thal proper

atplicat~ons

may

be Jaid

tO lhe b oltOIO

ofthe \Vaund . However, it (hould be

.wdl

attl'ndcd

.tl),

(hat

ComejimtfoJ

pretty

ntar

lhe intefline

,nei,ther run intó nor upon it; in which

c<lfe,

they muO: be o·

pencd, according to the courfc:oftheir pen·etration. T here

are abundance

01'

iníl:anc~s,

whe.re

lhe ¡nreCline is fo muen

ulccr"tcd, as to g¡ve free i!fue tO the maner of lhe abfcefs

by che

onul

but lhere a're none where there is not, by the

tbinneJs

aad diCcolouration of che Ikin, or an induratioo to

.be perceíved through the {kin, fome márk of its diretlion;

which , if difcovered, may be

op~Ded

into with a lancel,

..an1

[h~n

it becomes the Carne c.lfe as if the maner had failly

pointeQ .

·If

thejimifú

.iDto and about the gut are not corripJica–

'led .with an induration, aod you can follow lheír courre; tlle

mere opening w.ith rci(fars, or a knife guided on a direétor,

wiU fometimes fuffice ; hut it is generaJly fa fer to cut the

.piece of Jlefh furrounded by thefe ¡ncifioos quite away. and,

when it is calIous, abfolutely necetrary, or the callofilies

muíl: be waHed afterwards by efeh:crotick mtdicioes, which

is a tedious aod cruel method of cure.

When the fiffel' i, of.long flanding, and

\Ve

hae choice

.of time for opening ¡t, a dofe of rhubarb the day before the

operation will be very cooveoieDt, as it not only will empty

the bowels, but alfo prove ao aClrintcot for a while, OlDd

.prevent the mifcbief of reOloviDg the dreffings in order lO go

• 0

nool.

Jt fometimes happerfs, lhar lhe orífices are fa CmaH, as DOt

.to admil lhe entrance of the feitrars; in which cafe, fponge

.teou muO: be employed for their

dpu~tion.

Jo performing [hefe operatioos on

th~

onUI,

no inC1:ru–

·ments are fa handy

lhe knife and

fcilr.us

; almofl all

the others \\ hich lu\'e bec::n invented

facilitare lhe work

.are not ooly difficult tO manage. but more painful to the

palient : however, in lhore iDtlances -wbere the 6Uula is

.very oarrow, and apeos into the iotefHnes, juft: \Vithin the

Yergc of tpe

onUI,

the fyriogotomy may be ufcd with ad·

·vantage ; but whcre rhe opening ioto the gut is bigh, it

canoot be employed withour giving great pain.

The worfi fpecics of flauta is that communicaling witb lhe

<Jre/hra.

and rometimes (through the

profl.te

gland) with the

bl.dder itfelf. This generally nkes it rife from a former

go oorrh<Ea, and appears externally firO: in

p4rjn~0,

aod af–

ierw:crds increafing more.towards the

ImUJ,

and eTcn fome·

times iota lhe groio. burns oet io various orífices, through

-tbe 0('10, whích foon beeomes callous and rotten; and tbe

urioe paffing partly through thefe orífices, will often ex_

,cite a5 mucb paio, aod of lhe {ame kind, as a Clone io the

.bladd<r ..

Thi. fpeci.. of fiflula taking its rif" from flriélurcs of the

~rc,hra,

¡s only maoageable by the bougie ! for fa lone as

.be

urr/hra

ob~ ru(t<d,

tbe cure of the fiflula \ViJl be

¡mp.rfcél; but if the cao.l be opened by this application, i,

' J.\1azinz what obflinate induratioos aod foul

Ji"Ufol

will

conf~queoce

difappear ; lhough there are fome fo

t:atlOUt

anei

rolt~n,

to J elll3nd

lhe knife and ·fkilfu l drdlings.

nOlwithCb.nfling

lhe

ur~/"ra

fhould be dilaltd

lhe ure

bougies.

/h'Pllnélure

of /h,

P "'RlNEUM.

opcr;uion

performtcl, when lhe bladder

¡,

und~r

fuch a fupp rellioo of urine, as cannOl be relie\.led

any gen.

tlcr meth{'lds. nOI ,

reafon

lhe ob!lruaícn in ils ncck

or the

urdhra.

will tldmic of the introduélion of a ciuheter.

The maoner of

clom~

it, as defcribed by moH wrtters, is

plIfhing a

cor.lnlCln trocar flom lhe place where the ex–

ternal wound in

the

old

·.VAy

of cutting is made. ini.O ,he

cítvity of the bladd:-r. and fa procu ring thei(fue of {he

w¡·

ter through rhe c"nuJa ; but others, refiolng upon thí, prac–

tice, have ordercd d.n ineifion tO be carried

0 0

from che

fame part into the bladder, ind {hen to in(inuate the canu–

la : bUI b'oth lhe melhods are tO be

rej~éted,

ia favou r of

an opening

linle

~bo,~

the

puhiJ:

for befides tbat ir

is not eafy to guide lhe infiruOlent th rough the proClate

t1and ioto the t:.ladder. Ihe nece{ftty of

cootill~inf

it, io a

part alre::ldy very mucll iol1ame'd and truckened,. 'Cddom fails

mif~hief.

and evea lO produce a mortillcat.ioo.

Thc:re is another metbod

nill

more eafy I::fofh to the pa.

tient and the operator

which confitls onty in emptying the

bladder with a eommon frocar, ar.d Hopprng fhe canula with

a linte cork, which

afterward5 lO be takeDout as ofreo

as the p:uient has occafion to urine. The canula

i.s

to be

continued in the bladder, till fuch time as tbe pu[oo find,

he cao Toid bis UflOe hy rhe natural paíTage.

ID tbis operation the

abJflllun

ought to be perforated a–

bout

tWO

¡nches above the

pubj¡;

and if the patienr

be fat, the trocar (bould penetraté

[\Vo

¡Dches, otherwirc

a. iacb and a half will be fuRielOot.

Of Ih,

STO" ' .

.STONT

cODcretioos are a difeare ¡ncideot lo fef'eral parts

of tbe body; but we !hall treat oaly of ,hore formed iDthe

kidney. and bladder.

SmaU Hones and gravel are frequeDtly voided without

pain : but fometimes they collea and becomc very hrge in

lhe kidDey' ; ib which cafe, a lit of the !lone in that pan is

t.he

cure', frolD the infiammatioD aod paio occafioning 'coo–

vulGve ,,,¡tches, which at

tan

expel tbem. But in lhis dif–

eare fhe patieot

ver, much relieyed

feferaJ kinds

of remedies, fuch as the mucil:.ginoas. the fa ponaceous,

C:rc.

fome of which lubricate, aEld others both lubricate

and flimolate. The rand, in p. fli o: threugh the

ur<–

l~rJ.

is very mucb forw1Tded by the force of the urine.

The

ur~t~/J

being very n;¡rrow as they rua over {he

pfoOJ

murcie, aod alfo at theír entrance into the bladder, m..ke

the movement of fhe none very p.inrul and d.fficult in thore

P;ÚtS; but there is feldom fo much trouble a(ter che 6rll:

lit;

for when once th:

have ' been dilated, they

gen~rally

coatinue fo . For the rymptom. of a nooe in th.. bladder,

fee

MEDICINE,

1:22 .

S " 'CH t NC .

T H E

patient being Iaid

0 8

a horizontal tablc, wich hia

thighs elented ancj a litlle extended, paf, the rouod with

the CODcaTe pan towards you, until it meen witb Come re·

finanee

p!rjn~"

a linle above tbe anus; lhen lurning It

without much force, pu!h

¡,

gcotly

into the bladdcr¡ and

¡f