518 THE DISEASES OF THE HORSE 



promote the healing process by gninulatioii within. It is an old-fashioned 

 method, but attended with so much success as to merit notice as an 

 alternative to the more modern treatment, which consists in syringing out 

 the cavity with dilute carbolic acid, a solution of bichloride of mercury or 

 of Condy's Fluid, and attempting to retain a lotion similarly constituted on a 

 wetted pad in contact with the wound. The patient generally frustrates 

 these attempts on the part of the surgeon, and it is usually best to apply 

 dry powders in the shape of iodoform, boric acid, or salicylates which can be 

 dusted over the parts from time to time. 



If a fistula is once formed, or there is even reason to suspect it, heroic 

 measures should be taken. There is really nothing to be feared from the 

 use of the most powerful agents, and those men to be met with in different 

 parts of the country who undertake to cure on the piinciple of " no cure no 

 pay " meet with a large measure of success, because they have no fear of 

 bad consequences from the use of those destructive agents whose properties 

 they do not understand in any other connection. A cure is often effected 

 without obtaining a depending orifice or introducing a seton ; the powerful 

 escharotics employed appear to have the effect of sloughing out all the 

 impediments to discharge of the deep-seated matter, and granulation taking 

 place from the bottom of the wound eventual recovery is certain. 



This rough, and, as we have said, often successful method of treatment 

 does not commend itself to the modei'n surgeon, who will accomplish his 

 aim with greater certainty by observing the usual rules and seeking for 

 effectual drainage, sometimes by the introduction of a drainage tube, at 

 others by a seton, as circumstances may dictate. A tube ma}^ be pushed 

 into the furthermost extremity of the sinus when it is not possible, from its 

 situation, course, and direction, to obtain a dependent orifice. The tubing 

 sold by chemists for infants' feeding-bottles answers the purpose well, when 

 notches have been cut at intervals of about an inch throughout the length 

 to be used. It may be retained in place by a couple of stitches through 

 the lips of the wound. Caustic solutions should be introduced by means 

 of a syringe each time that the drainage tube is taken out and cleared of 

 the matter which has a tendency to accumulate within it. The remedies 

 usually selected are chloride of zinc, bichloride of mei'cury, sulphates of 

 copper and zinc, and acetate of lead. The first-named has such an affinity 

 for water, that when a solid stick of it is pushed into a sinus it will do its 

 work more rapidl}' than any other agent, finding its way to the branches of 

 a fistula, and occasionally succeeding when others have failed. Its chief 

 disadvantage is, that when it has done its work the parts arc so long a 

 time in commencing to granulate. Bichloride of mercury either alone or in 

 combination with sulphate of copper is most affected by the hereditary 

 " specialist " referred to above. Kitrate of silver, in the large quantities 

 often needed for established fistula, is expensive, and no better than the 

 remedies named for destruction of the sinus, but promotes healthy and 

 durable granulations in the final stage. If the discharge decreases in 

 quantity and becomes thicker, assuming the appearance of healthy pus, 

 and a probe brings up a stain of bright-red blood, it may be assumed that 

 repair is taking place, whether or no a slough or " core " has been cast out 

 of the wound. The caustic dressings will be no longer needed, cleanliness 

 and free drainage being all that is necessarv. 



