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The glans was riddled with holes, and numerous fistulae existed on the inferior surface of the urethra, the meatus being impermeable. So great was the weight and hypertrophy that amputation was necessary.
Thus in his discussion of dislocation of the femur Roger says: Si crus a coxa sit disjunctum, eadem sit cura quam et in disjuncturam brachii et cubiti diximus, etc. The general subject of fistulae is treated at considerable length on folio 205b, and fistula lachrymalis and fistulae of the jaw receive special attention in their appropriate places.
Operations on the bladder or urethra are not dangerous or liable to be followed by abortion. Operations for vesicovaginal fistulae should not be done, as they are dangerous, and are liable to be followed by much hemorrhage and abortion. Plastic operations may be done in the earlier months of pregnancy with fair prospects of a safe and successful issue.
Moreover, since the sclero-corneal incision is uniformly oblique, the position and extent of the external wound does not always furnish evidence of the character of the internal wound. In all likelihood many cases of relief or cure following iridectomy are those due to the formation of cystoid scars or minute fistulae, rather than as a result of the removal of a portion of the iris periphery.
If suppuration occurs, it is necessary to provide for drainage as soon as it is possible to distinguish the presence of pus. Due regard is given the manner of establishing drainage because of the usual existence of sub-fascial fistulae. In these cases, one avoids injecting solutions of aqueous antiseptics.
Not less than fifty chapters are devoted to a comparatively full discussion of wounds, fractures and dislocations, lithotomy, herniotomy, fistulae and the various diseases on the border line between medicine and surgery. Not a single surgical writer, however, is quoted by name.
The patient was a girl of eighteen, who had previously had perityphlitis, followed by abscesses about the navel and lumbar region. Two fistulae were found in the right loin, and were laid open into one canal, which, after partial resection of the 12th rib, was dilated and traced inward and upward, and found to be in connection with the stomach.
Ureterovaginal fistulae following total extirpation of the uterus, opening of pelvic abscesses, or ulcerations from foreign bodies, are repaired by an operation termed by Bazy of Paris ureterocystoneostomy, and suggested by him as a substitute for nephrectomy in those cases in which the renal organs are unaffected.
Where extensive sub-coronary fistulae result, either from lack of prompt or proper attention, the condition is then one requiring a radical operation to establish drainage and to disinfect if possible, the suppurating tissues. Corns. Etiology and Occurrence.
Gilbert's surgical chapters discuss the general treatment of wounds and their complications, and more specifically that of wounds of the head, neck, throat, wounds of nerves, of the oesophagus, scapula, clavicle, of the arm, the stomach, intestines and the spleen; fractures of the clavicle, arm, forearm and ribs; compound fractures; dislocations of the atlas, jaw, shoulder and elbows; fistulae in various localities, and the operations on the tonsils and uvula, on goitre, hernia and stone in the bladder, etc. certainly a surgical compendium of no despicable comprehensiveness for a physician of his age and country.
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