Note 49 — PART SECOND. OF PARTICULAR SURGICAL SUBJECTS. (continued 8)

[Until recently it was the opinion of surgeons, almost universally, that the fistula opened into the bowel at the distance of from two to three inches from the anal outlet; an error which often led to severe and hazardous operations, by which the unfortunate patient was sometimes rendered miserable for life. Mons. Ribes of Paris, who was the first to investigate the subject in a careful and extended manner, ascertained that the internal orifice is generally situated immediately above the place where the lining membrane of the rectum unites with the skin, sometimes a little higher, but never more than five or six lines. In eighty subjects affected with this malady it did not exceed this elevation, and in a considerable number it was not higher than a third or fourth of an inch. In my own operations and dissections I have rarely found the internal aperture more than a line or two above the internal sphincter muscle. The observations of the late Professor Bushe, of New-York, tend to a similar conclusion.—ED.]