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up the part while matters are so, no clots of blood being allowed to remain in the opening. Then having applied a double compress, and wetted it with wine, apply above it clean wool which has been smeared with oil. For, although the flow of blood be violent, it will be stopped in this way. If a thrombus be formed in the opening, it will inflame and suppurate. Venesection is to be practiced when the person has dined more or less freely and drunk, and when somewhat heated, and rather in hot weather than in cold.

17. When in cupping, the blood continues to flow after the cuppinginstrument has been removed, and if the flow of blood, or serum be copious, the instrument is to be applied again before the part is healed up, so as to abstract what is left behind. Otherwise coagula of blood will be retained in the incisions, and inflammatory ulcers will arise from them. In all such cases the parts are to be bathed with vinegar, after which they are not to be wetted; neither must the person lie upon the scarifications, but they are to be anointed with some of the medicines for bloody wounds. When the cupping-instrument is to be applied below the knee, or at the knee, it should be done, if possible, while the man stands erect.'

'The object in directing the cupping-instrument to be applied while the patient stands erect would seem to be, as Foës remarks, that the skin will thus be in its natural state, and the blood will flow the more freely. Yet, although the direction seems to be a very proper one, it is not attended to by modern practitioners of the art of cupping.

ON FISTULE.

ON FISTULE.

THE ARGUMENT.

THIS little tract is evidently a continuation of the work "On Ulcers,' and is equally replete with interesting and important matters. As stated in the Preliminary Discourse, the ancient authority in support of its genuineness is very strong.

In the first paragraph, the author gives an account of the formation of fiustula in ano, which he attributes to tubercles, or to injuries inflicted on the parts adjoining to the anus, in riding, rowing, or from any such act of violence.

His first advice is, that the surgeon should lose no time in making an incision, even before the matter is fully formed. If the fistula already exist, the surgeon is to examine it with a stalk of fresh garlic. Then the herb seseli is to be given as a diuretic, and the bowels cleared out by means of purgatives. (§ 2.)

In the third paragraph is described the first method of treating fistula. in ano, namely, by introducing into it a tent formed from a strip of linen. (or cotton), cloth, smeared with the caustic juice of one of the spurges (euphorbia); after which a round ball, resembling a modern pessary, is directed to be introduced per anum, the object of which, as stated by Foës, may have been to expand the sore, so as to allow the caustic to be well diffused over it; or, perhaps, it was merely meant to keep the tent secured in the fistula. On the sixth day the tent is to be removed, and, the ball being filled with alum, it is to be again introduced, and allowed to remain for a time. The object of this second introduction of the ball, is not to me sufficiently clear; perhaps it was to keep the sides of the fistula expanded while in the process of healing. Myrrh is to be applied, probably with the intention of cleansing the sore.

In the fourth paragraph, the apolinose, or operation by the ligature, is described in a very minute and circumstantial manner. No one who reads the description can mistake the principle of the operation, whatever difficulty he may find in understanding certain expressions contained in it. The object evidently is to cut open the fistula by gradually tightening a thread which has been passed through both its orifices, and at the same time to raise up a healthy action in the part. When the fistula is fairly

laid open, pieces of sponge, smeared with some gentle escharotic, such as the flos æris, are to be applied with the view of consuming the callous flesh, and keeping the fistula expanded until it heal equally.

In the fifth is described the treatment when the disease consists of several sinuses which are not all fairly laid open by the preceding process; in which case our author directs the sinus to be syringed with a stimulant and escharotic injection, so as to remove all the callous parts.

In the sixth, a most accurate description is given of an acute attack of phlegmon in the neighborhood of the anus, with the treatment thereof by hip-baths, cataplasms, suppositories, and various other stimulant and soothing applications.

In the seventh, strangury is correctly described upon the principles of the humoral pathology.

In the eighth paragraph, another common and very serious aggravation of these complaints is minutely described, and the treatment is carefully laid down. In certain cases, astringent and escharotic applications of a powerful nature are to be made.

In the ninth is described the mode of procedure when great difficulty is experienced in accomplishing the reduction of the gut. The treatment in this case consists in rest and the application of suitable astringents.

In the tenth is explained the treatment of procidentia ani when attended with discharge of blood. It consists either of astringent cataplasms, containing wakerobin, wild vine, etc., or narcotics, such as the seed of hemlock.

In the eleventh is described the treatment when inflammation comes The applications consist of cataplasms, formed principally of astringent and sedative articles, such as ivy, mandrake, and the like.

on.

When the pain is unattended with inflammation, the applications recommended are of a stimulant nature, such as natron, alum, roasted salts, the green leaves of capers, and the like; but they are to be varied according to the nature of the complaint. See the last paragraph. From what has now been stated with regard to the contents of this treatise, it will be readily allowed, that the author of it had formed a very correct idea of the nature of the disease; and that the plans of treatment he lays down are all very rational, and bespeak an accurate acquaintance with the subject.

Gruner and Ackerman argue against the genuineness of this treatise, from the circumstance of its containing a manifest allusion to the humoral. pathology in the seventh paragraph. But if this were sufficient reason for regarding it as spurious, we ought, on the same grounds, to reject the Aphorisms, in which, as we have seen, there are frequent and decided allusions to the hypothesis of the humors. And it is to be borne in mind, that Galen invariably represents Hippocrates as the founder of the

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