SURGERY - likely to allay the constitutional irritation. He must then wait until the operations of nature have separated the sloughs caus ed by the urine, endeavouring, however, to introduce an elastic catheter, where he should allow it to remain. Poultices, fomentations, and the warm bath, should be resorted to, if there are any appear-' ances of inflammation ; and abscesses, or accumulations of urine, should be open ed 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 he carefully drawn off at regular intervals ; cold bathing, bark, blistering the sacrum or perineum, electricity, tincture of can tharides internally, &c. will be of service.
Sometimes the patient can hold his urine to a certain degree, when an irre sistible 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 la bia have their opposed surfaces grown together, leaving perhaps merely a small opening, through which the urine is im perfectly discharged, but marked with a line, showing the proper distinction. This may be congenital, or the effect of disease. Sometimes a thin membrane closes both the meatus urinarius and va gina in newly born children. In both these cases the use of the knife is neces sary ; and lint should be interposed be tween the divided surfaces. There is another form of the same malformation, 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 mem brane must be divided to discharge the accumulated menses, and the edges date, cut kept asunder.
Imperforate auras. The part may either be closed by a membrane, or be too con tracted to allow the feces to be evacuated. It may he 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 mem brane is the remedy ; and in the second, a dilatation of the contracted part by the crooked bistoury. If an obstruction should be discovered within the gut, it May be perforated with the trochar, in troduced 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 punc tured.
Fistula in ano. Any formation of mat ter near the anus is very likely to termi nate in this complaint ; the suppuration extends in the fat and cellular substance round the rectum, and sinuses form, hav ing small external apertures, and seldom healing without an operation. The com mencement of the disorder may be a phlegmonous abscess, attended with con siderable sympathetic fever ; or it may have a more erysipelatous character, spreading more widely, being more su perficial, 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 re tention of urine, strangury, prolapses and tenesmus, piles, &c. are produced. The complaint sometimes begins in an indu ration 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 open ing, or from several.' Sometimes there is not only an external aperture, but ano ther internal one, communicating with the cavity of the intestine.