A soft poultice and fomentation. are the best means of treating these abscess es ; which, if they are phiegmonous, 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 ex tension of the malady. The general treatment must correspond with the na ture 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 neces sary 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 surgeon's left fore finger. If the fistula should not have pe netrated the gut, the bistoury should be pushed through its 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 The probe may now be withdrawn, and the operation completed by bringing the knife out with its point applied to the finger which was in the intestine; and thus all between the edge of the knife and the anus must be divided. A soft piece of lint should now be placed in the wound, and remain un til it is loosened by suppuration, and all the future dressings should be mild and unirritating. The callosities, of which
surgeons have complained so much in these cases, arise from injudicious treat ment, and particularly from the use of caustic and stimulating applications.
Proiapsue alai. The internal coat of the gut may be protruded through the sphincter ; or a portion of the intestine with all its coats may descend. Causes which weaken the sphincter, and such as force the intestine downwards, contri bute to this affection. Costiveness, te nesmus kept up by hemorrhoids, as carides. 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, fo. mentations and poultices, or leeches and cold washes, are necessary. Horizontal posture, and avoiding costiveness, are very important points. A compress and bandage may be necessary to retain the replaced gut ; and astringent clysters have been advised. If the protruded part has become indurated, thickened, and painful, and will not admit of reduc tion, it may be extirpated. Sometimes an introsusception, commencing at the czeum, has protruded at the anus. This case is quite beyond the powers of art.
Prolapeue, juvenile, and retroversio uteri, are considered under the article MID WIFERY.