. The anatomy and surgical treatment of abdominal hernia. resemble each other, bothin their structure and office; they are both excrementitious outlets, com-posed of a mucous lining, and under the influence of muscular contrac-tion ; and from this analogy there is strong reason to conclude, that anoperation which succeeds in closing a fistula in the one, would also an-swer in the other. The edges of the opening in the integuments havingbeen pared off, a portion of integument should be raised from the neigh-bouring surface, leaving a neck of attachment undivided, and be laid overthe opening, to
. The anatomy and surgical treatment of abdominal hernia. resemble each other, bothin their structure and office; they are both excrementitious outlets, com-posed of a mucous lining, and under the influence of muscular contrac-tion ; and from this analogy there is strong reason to conclude, that anoperation which succeeds in closing a fistula in the one, would also an-swer in the other. The edges of the opening in the integuments havingbeen pared off, a portion of integument should be raised from the neigh-bouring surface, leaving a neck of attachment undivided, and be laid overthe opening, to the edges of which it should be united by small silk liga-tures. As a preliminary step it would be advisable to evacuate the bowelsby purgatives and enemata, in order that they may be called into actionas little as possible during the process of union. M. Dupuytren, to whom I feel greatly indebted for various acts ofkindness and much information, when I visited Paris in 1825, has sug-gested an ingenious mode of remedying this defect, when combined with. a loss of the entire cylinder. It consists of a pair of screw forceps, oneblade of which is passed into each mouth of the intestine, and a degree of MORTIFICATION OF THE INTESTINE. 137 pressure is kept up on the intervening septum, sufficient to produce ulce-ration, and thus open a communication between the parallel canals. Itdoes not, however, appear from the cases related by this able surgeon,that it succeeds in all cases in wholly closing the artificial opening; butit obtains for the patient an exchange of an artificial anus for a faecal fis-tula; the faeces pass by their natural channel, while a small fistula remains,from which a fluid discharge continues to ooze.* * For an account of this instrument see Graefe and Walters Berlin Journalfor 1821, in a review of a work by Breschet; also Reisingers work, Ausburgh,1817. This sketch of the instrument is taken from the former work.—Ed. 18 CHAPTER XII. Of the Treatment after th
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