The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . harge. The operation for complete fistula should be performed in the follow-ing way. The bowels having been well cleared out the day before with adose of castor-oil, and an enema administered on the morning of the ope-ration, the patient should be laid on iiis left side, with the nates project-ing over the edge of the bed; a probe must then be passed through thefistulous track into the rectum, and the Surgeon, introducing tlie fore-finger into the gut, feels for the end of the instrument; he then
The science and art of surgery : being a treatise on surgical injuries, diseases, and operations . harge. The operation for complete fistula should be performed in the follow-ing way. The bowels having been well cleared out the day before with adose of castor-oil, and an enema administered on the morning of the ope-ration, the patient should be laid on iiis left side, with the nates project-ing over the edge of the bed; a probe must then be passed through thefistulous track into the rectum, and the Surgeon, introducing tlie fore-finger into the gut, feels for the end of the instrument; he then [)asses ashort strong-bladed probe-pointed bistoury of al)Out the size and shapeof that represented in the annexed figure (700) through the fistula, usingthe probe as a guide, though in some cases this may conveniently bedispensed with. When he feels the end of the knife projecting into therectum through the internal apeiture of the fistula, he, after withdraw-ing the pr()l)e, hooks ids forefinger over it (Fig. 701), and by a sweepingVOL. II.—44 690 DISEASES OF THE LARGE INTESTINE AND Fig. 701.—Operation for Fis-tula in Ano. and pressing cnt, raising the handle of the instrument at the same timethat lie pushes down its point, brings both finger and blade out at theanal aperture, cutting through the whole thickness of the parts betweenthis and the fistula, so as to lay the two cavities into one. Care shouldbe taken to divide the sphincter in a direct and not an oblique manner,lest a flap or fold be left whicli willinterfere with the proper healingof the wound. In performing thisoperation, the Surgeon shouldcut with his left hand if the fis-tula be upon the left side; and ineither case should be careful notto wound his own finger, as suchcuts often prove troublesome inhealing. Where the external aper-ture or apertures of the fistulaare at some distance from thegut, the integuments being under-mined to a considerable extent,perhaps thinned, soft, and bluish, all the su
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