FISTULA IN ANO.

367

When the bottom and sides of an ulcer seem hard and callous,they may be sprinkled twice a-day with a little red precipitate ofmercury, and afterwards dressed with the ointment of yellow ba-silicon, or cerate of resin. Sometimes it will be necessary to havethe edges of the ulcer scarified with the lancet.

Limewater has frequently been known to have very happy effectsin the cure of obstinate ulcers. It may be used in the same man-ner as directed for the stone and gravel. For indolent ulcers, Su-Everard Home recommends the application of diluted nitrous acid,in the proportion of a scruple to eight ounces of water. It pro-motes, in an uncommon manner, the progress of the cure ; and,although painful at first, this sensation soon ceases, and producesthe best effects.

My late learned and ingenious friend Dr. White strongly recom-mends the use of the solution of corrosive sublimate of mercuryin brandy, for the cure of obstinate ill-conditioned ulcers. I havefrequently found this medicine, when given according to the Doctor'sdirections, prove very successful. The dose is a table-spoonfulnight and morning ; at the same time washing the sore twice orthrice a-day with it. In a letter which I had from the Doctor a lit-tle before his death, he informed me, "that he observed washingthe sore thrice a-day with the solution of a triple strength was»ery beneficial."*

The carrot poultice is found to agree with a great many irrita-ble sores ; and the decoction of poppy-heads is also found to be agood liquor for making poultices. The great objection to poulti-ces in these cases being their weight, the limb should always, it"possible, rest upon the poultice, and not the poultice, upon thelimb. When the weight cannot be avoided and is hurtful, a lighterapplication should be chosen. When poultices are employed, theiruse should be continued as long as the granulations are small, andthe ulcer rapidly diminishing in size; and this, even until the cica-trization be complete. When the granulations become large andloose in their texture, poultices should be left off, when a slightor necessary degree of pressure may be adopted.

Of the Fistula in Ano.

Ulcers in the neighbourhood of the anus are peculiarly liable tobecome fistulous, and when in that state are very difficult to cure.A fistula, is frequently the consequence of neglected or ill-treatedpiles. The presence of this complaint is discovered by the sensa-tion of a pricking pain on going to stool, which is also perceivedduring the exertion of coughing or sneezing. On examination, astain of a pale colour, occasionally accompanied with a littleblood, will be found upon the linen ; the fijeces are also slightlystreaked with matter. This matter issues from a small ulcer withone or more orifices, in the neighbourhood of the anus, the otherextremity of which generally communicates with the internal cav-ity of the rectum.

* In ulcers of the lower limbs great benefit is often received from wearing a lacedstocking, as this prevents the flux of humours to the sores, and disposes them to heal.