Observations pratiques sur certaines des maladies du rectum, l'anus, et textures contigus : donner à leur nature, siège, causes, symptômes, conséquences, et la prévention, notamment adressée à l'reader . ugh un ou plusieurs sinus ou ouvrir l'explosif. Ces fistuleuses sinus ou passages, sont generallysingle ramify ; mais ils ont parfois à leurs extrémités,généralement de communiquer les uns avec les autres, et la convergence interne toone aperture. Leur direction est la plupart du temps-yetthey tortueux sont parfois droit, et présente de nombreuses dilatations contractionsand dans leurs cours. Fistulse ont été divisé

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Practical observations on some of the diseases of the rectum, anus, and contiguous textures : giving their nature, seat, causes, symptoms, consequences, and prevention, especially addressed to the non-medical reader . ugh one or more sinuses or open-ings. These fistulous sinuses or passages, are generallysingle; but they sometimes ramify at their extremities, usually communicating with each other, and converging toone internal aperture. Their direction is mostly tortuous—yetthey are sometimes straight, and present numerous contractionsand dilatations in their course. Fistulse have been divided into three classes: completefistula; external blind fistula, and internal blind, or occultfistula. The first signifies that the sinus communicates withthe bowel, and opens externally, forming a continuous canalfrom the cutaneous surface up into the intestine; the seconddenotes that the sinus, opens only externally, and the third, that the sinus opens only into the bowel. These two last arealso called incomplete fistulas. (Vide Plate IV.) Some authors deny the existence of any other but com-plete fistulse; but this is a great error, as I have demon- PLATE W. Vistula complicated ivdth piles ^^^^*^sv^%»s, „^._. a. Piles . b. ^Fistulous opeiini^^iOi^ro^eiLiit;. FISTULA IN ANO. 105 strated by minute desection, in numerous cases—some of longstanding. With regard to the number and form of the external andinternal orifices, they vary materially. Generally, there isbut one external opening; yet often, there are as many asthree, four, and six, and I have seen in consumptive patientsas many as ten and twelve. All these, however, usuallycommunicate with each other, and converge to one internalaperture. There is but rarely more than one internal open-ing ; yet I have seen as many as two, and even three. Theyare usually round and callous. Sometimes, however, theyare quite soft. The external openings are commonly round, and studded with exuberant granulations which sometimesvery easily bl

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