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Author and Proprietor of the Philosophical Journal, and various other Chemical, Philosophical, and
likely to allay the constitutional irritation. He must then wait until the operations of nature have separated the sloughs caused by the urine, endeavouring, however, to introduce an elastic catheter, where he should allow it to remain. Poultices, formentations, and the warm bath, should be resorted to, if there are any appearances of inflammation; and abscesses, or accumulations of urine, should be opened early and freely. Incontinence of urine. Sometimes this fluid dribbles away without any sensation of the patient. Here paralysis of the bladder is the cause, and may be induced in various ways, as from injuries of the spine, over distension of the organ, &c. In the latter case, the urine should be carefully drawn off at regular intervals; cold bathing, bark, blistering the sacrum or perineum, electricity, tincture of cantharides internally, &c. will be of service. Sometimes the patient can hold his urine to a certain degree, when an irresistible propensity to evacuate it comes on. Here irritability of the bladder is the cause, and may be induced by bad piles, fistula in ano, &c. Opium, the warm bath, fomentations, diluting drinks, &c. may be resorted to when no obvious cause appears. Imperforate vagina. Sometimes the labia have their opposed surfaces grown together, § perhaps merely a small opening, through which the urine is imerfectly discharged, but marked with a ine, showing the proper distinction. This may be congenital, or the effect of disease. Sometimes a thin membrane closes both the meatus urinarius and vagina in newly born children. In both these cases the use of the knife is necessary; and lint, should be interposed between the divided surfaces. There is another form of the same mal-formation, in which the vagina alone is closed ; and no symptoms appear until puberty, when the menstrual discharge does not flow. The uterus swells, and at last a kind of labour pains comes on. Here the membrane must be divided to discharge the accumulated menses, and the edges of the cut kept asunder. Imperforate anus. The part may either be closed by a membrane, or be too contracted to allow the feces to be evacuated. It may be rightly formed at its outer part, but terminate in a cul de sac ; or there may be no vestige whatever of anus. In the first species, a division of the membrane is the remedy ; and in the second, a dilatation of the contracted part by the ‘WOL. VI.
crooked bistoury. If an obstruction should be discovered within the gut, it may be perforated with the trochar, introduced according to the course of the intestine. The latter species is attended with very little hope of saving life. The surgeon may cut in the situation of the anus, and follow his dissection along the sacrum, in order to find the end of the gut, which, when found, should be punctured. Fistula in ano. Any formation of matter near the amus 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 external apertures, and seldom healing without an operation. The commencement of the disorder may be a phlegmonous abscess, attended with considerable sympathetic fever; or it may have a more erysipelatous character, spreading more widely, being more superficial, and attended with depression of the powers of the constitution. The former is seen in young, strong, and healthy subjects; the latter in weakened, intemperate, and unhealthy constitutions. The parts in the neighbourhood of the disease are often affected; and hence retention of urine, strangury, prolapsus and tenesmus, piles, &c. are produced. The complaint sometimes begins in an induration of the skin near the anus without pain. This hardness gradually softens and suppurates. The matter 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. Sometimes there is not only an external aperture, but another internal one, communicating with the cavity of the intestine. A soft poultice and fomentations are the best means of treating these abscesses; which, if they are phlegmonous, should not be opened until the skin has become thin ; but, when they are of the . erysipelatous kind, should be punctured immediately, to prevent any further extension of the malady. The general treatment must correspond with the nature of the constitutional disturbance. In all abscesses about the anus, the incision should comprehend all the skin covering the matter, as the cavity is then most likely to fill up from the bottom. The dressing should be small in quantity, light, and unirritating. If, 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 S S