. American practice of surgery ; a complete system of the science and art of surgery . incised; if there is a suppurating urethritis it should firstbe relieved and tne urine made as bland and as unirritating as these conditions have been relieved, then attention should be given tothe fistula. That portion of it which is located near the anus should be thor-oughly laid open and curetted; the remaining portion, wliich terminates atthe uretlira, should be thoroughly ckained, curetted, and treated from time totime with stimulating appHcations, care being taken not to let any of ther
. American practice of surgery ; a complete system of the science and art of surgery . incised; if there is a suppurating urethritis it should firstbe relieved and tne urine made as bland and as unirritating as these conditions have been relieved, then attention should be given tothe fistula. That portion of it which is located near the anus should be thor-oughly laid open and curetted; the remaining portion, wliich terminates atthe uretlira, should be thoroughly ckained, curetted, and treated from time totime with stimulating appHcations, care being taken not to let any of theremedy get into the urethra. (6) Redo-urethral FistidoB.—A fistula of this character is a much more seri-ous condition and more difficult to cure than the preceding one. The fistuloustract connects the urethra with the rectum, and the fact that it receives itsinfection from both sources makes it much more difficult to heal than the com-mon type of ano-rectal fistula. The membranous and prostatic portions ofthe urethra are those which are involved^ and the opening in the rectimi is. Fig. 334.—Second Stage of ChetwoodsOperation. (From Tuttle: Diseases ofthe Anus, Rectuni, and Pehdc Colon. & Co., Xew York.) 830 AMERICAN PRACTICE OF SURGERY. generally located above the internal sphincter. AVhile the prmiary diseasebegins, as a rule, in the urethra and empties its products secondarily into therectum at a lower point, yet, in a certain number of cases, the opening intothe rectum will be found to be located at a considerably higher level than theurethral opening, and therefore it is presumably fair to infer that, in thesecases, the disease began in the rectum. As to the etiolog}^ and pathology of this variety of rectal fistula?, we areunable to say more than that they are due either to traumatism or to somepathological process. The most characteristic s3aTiptom of this lesion is the passage of urinethrough the rectum, or of fecal matter and gas with the urine. The heigh
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