The practice of surgery . ant sepa-rates the nates to the full. The surgeon, seated, inserts the probe,taking especial care to lodge its extremity in the bowel through theulcerated internal opening. The probe may be grooved, so as to admitof a curved, strong, probe-pointed bistoury being passed along it; or,the probe having been withdrawn, its place is occupied by the bistoury—used at first merely as a probe. The point is then met in the bowelby the fore-finger of the other hand—right or left, according to circum-stances, for here ambidexterity is essential—and with the point pressingfirmly on
The practice of surgery . ant sepa-rates the nates to the full. The surgeon, seated, inserts the probe,taking especial care to lodge its extremity in the bowel through theulcerated internal opening. The probe may be grooved, so as to admitof a curved, strong, probe-pointed bistoury being passed along it; or,the probe having been withdrawn, its place is occupied by the bistoury—used at first merely as a probe. The point is then met in the bowelby the fore-finger of the other hand—right or left, according to circum-stances, for here ambidexterity is essential—and with the point pressingfirmly on the finger, and with the edge moved in a gently sawing motion,both hands are brought down towards the operator, causing division ofall that is within the concavity of the instrument. When this is ofconsiderable thickness, or of almost cartilaginous density—as not un-frequently is the case—a particularly stout and Veil-tempered blademust be selected for the service, lest it give way. It is unnecessary, Fig. Plan of the operation of Fistula in Ano, the finger and biitoury met in tin- rectum previousl] to i however, to divide any great extent of parts, for the following reasons:There is almost always an internal opening; this is invariably situatealmost immediately within the sphincter; it is essential to make the line 416 FISTULA IN ANO. of division pass through this aperture; but that having been done, thereis in no case any necessity for passing the knife higher, however exten-sive the fistula may be. It is by no means uncommon to find the trackpassing higher than the internal opening ; yet in these cases the ordi-nary operation is all that is necessary ; the knife entering at the ulcer-ated opening, and no higher. One obvious advantage of this is, theavoidance of danger from loss of blood. A high wound might implicatearterial branches of considerable importance. In the approved opera-tion, only small branches will spring; they are seen at the time of di-vision
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