File:American practice of surgery; a complete system of the science and art of surgery (1906) (14763325582).jpg

Identifier: americanpractic07brya (find matches)
Title: American practice of surgery ; a complete system of the science and art of surgery
Year: 1906 (1900s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914, ed Buck, Albert H. (Albert Henry), 1842-1922
Subjects: Surgery
Publisher: New York, W. Wood and company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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much more frequent than the occurrence of fistulse intuberculous subjects, makes it very probable that primary tuberculosis does * ■• Anat. patli. generale Paris. 1S49, page 549. 816 AMERICAN PRACTICE OF SURGERY. occur in these parts. Notwithstanding the observations of Koch to the contrary,modern observers have conckided that inoculation of the tissues in and aroundthe rectum may take place directly through injuries and abrasions, the tuberclebacilli which are taken in with the food and passed through the alimentarycanal acting the part of infective agents. If it can once be clearly establishedthat the rectal manifestations of the tuberculosis is, in certain cases, the initialand only focus of the disease, then this fact—taken in connection with thefurther fact that this focus is in most cases absolutely walled off (see p. 792)—should have a most important bearing on the management of these cases.So far as is definitely known, syphilis is related to ano-rectal fistulse only,
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Fig. 330.- -lllustrates Certain Forms of Anal Fistula,internal fistula; C, complete fistula. A, Blind external fistula; B, blind(Earle and Tuttle.) or chiefly, in regard to the strictures which it may cause. In these cases thefistulse are due to perforation of the rectal wall by ulcerative processes of anon-syphilitic nature, and then subsequently the perirectal tissues become in-fected with syphilis. Ano-Rectal Fistula.—An ano-rectal fistula represents an abnormal channelof communication between the anus or the rectum and the surrounding tissuesor the surface of the neighboring skin. Symftoms and Diagnosis.—The symptoms should not include the acutemanifestations which attend the formation of the abscess, but only those phe-nomena which are generally observed in connection with the fistula after it hasformed. After the evacuation of the pus has caused a subsidence of theacute inflammatory symptoms of the abscess, the healing process, instead ofprogressing, as is usual under such c

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