M. M. A warmer night-cap. Warmish water should be gently syringed into the ear to keep it clean twice a day; and if it does not heal in a week, a little spirit of wine should be added; first about a fourth part, and it should be gradually increased to half rectified spirit and half water: if it continues long to discharge matter with a very putrid smell, the bones are injured, and will in time find their exit, during which time the ear should be kept clean by filling it with a weaker mixture of spirit of wine and water; or a solution of alum in water; which may be poured into the ear, as the head is inclined, and shook out again by turning the head, two or three times morning and evening. See Class [II. 1. 4. 10].
[9]. Fistula lacrymalis. The lacrymal sack, with its puncta lacrymalia and nasal duct, are liable to be destroyed by suppuration without fever; the tears then run over the eyelids, and inflame the edges of them, and the cheeks, by their perpetual moisture, and saline acrimony.
M. M. By a nice surgical operation a new aperture is to be made from the internal corner of the eye into the nostril, and a silver tube introduced, which supplies the defect by admitting the tears to pass again into the nostril. See Melanges de Chirurgie par M. Pouteau; who thinks he has improved this operation.
[10]. Fistula in ano. A mucous discharge from the anus, called by some white piles, or matter from a suppurated pile, has been mistaken for the matter from a concealed fistula. A bit of cotton wool applied to the fundament to receive the matter, and renewed twice a day for a week or two, should always be used before examination with the probe. The probe of an unskilful empyric sometimes does more harm in the loose cellular membrane of these parts than the original ulcer, by making a fistula he did not find. The cure of a fistula in ano of those, who have been much addicted to drinking spirituous liquor, or who have a tendency to pulmonary consumption, is frequently of dangerous consequence, and is succeeded by ulcers of the lungs, and death.
M. M. Ward's paste, or 20 black pepper-corns taken after each meal twice a day; the pepper-corns should be cut each into two or three pieces. The late Dr. Monro of Edinburgh asserted in his lectures, that he had known a fistula in ano cured by injecting first a mixture of rectified spirit of wine and water; and by gradually increasing the strength of it, till the patient could bear rectified spirit alone; by the daily use of which at length the sides of the fistula became callous, and ceased to discharge, though the cavity was left. A French surgeon has lately affirmed, that a wire of lead put in at the external opening of the ulcer, and brought through the rectum, and twisted together, will gradually wear itself through the gut, and thus effect a cure without much pain. The ends of the leaden wire must be twisted more and more as it becomes loose. Or, lastly, it must be laid open by the knife.
[11]. Fistula urethræ. Where a stricture of the urethra exists, from whatever cause, the patient, in forcing the stream of urine through the structure, distends the urethra behind it; which after a time is liable to burst, and to become perforated; and some of the urine is pushed into the cellular membrane, occasioning fistulas, which sometimes have large surfaces producing much matter, which is pressed out at the time of making water, and has been mistaken for a catarrh of the bladder; these fistulas sometimes acquire an external opening in the perinæum, and part of the urine is discharged that way.
Can this matter be distinguished from mucus of the bladder by the criterion delivered in Class [II. 1. 6. 6]?
M. M. The perpetual use of bougies, either of catgut or of caoutchouc. The latter may be had at No. 37, Red-lion street, Holborn, London. The former are easily made, by moistening the catgut, and keeping it stretched till dry, and then rounding one end with a pen-knife. The use of a warm bath every day for near an hour, at the heat of 94 or 96 degrees, for two or three months, I knew to be uncommonly successful in one case; the extensive fistulas completely healing. The patient should introduce a bougie always before he makes water, and endeavour to make it as slowly as possible. See Class [I. 2. 3. 24].
[12]. Hepatitis chronica. Chronical inflammation of the liver. A collection of matter in the liver has frequently been found on dissection, which was not suspected in the living subject. Though there may have been no certain signs of such a collection of matter, owing to the insensibility of the internal parts of this viscus; which has thus neither been attended with pain, nor induced any fever; yet there may be in some cases reason to suspect the existence of such an abscess; either from a sense of fulness in the right hypochondre, or from transient pains sometimes felt there, or from pain on pressure, or from lying on the left side, and sometimes from a degree of sensitive fever attending it.
Dr. Saunders suspects the acute hepatitis to exist in the inflammation of the hepatic artery, and the chronical one in that of the vena portarum. Treatise on the Liver. Robinson. London.