FISTULAS. 479 



saltpeter three times a day in his water or feed. If the fever runs 

 high, 20-drop doses of tincture of aconite root every two hours may 

 be administered. The local application of cold water to the inflamed 

 spot for an hour at a time three or four times a day has often proved 

 very beneficial, and has afforded great relief to the patient. 



Cooling lotions, muriate of ammonia, or saltpeter and water ; seda- 

 tive washes, such as tincture of opium and aconite, chloroform lini- 

 ment, or camphorated oil, are also to be frequently applied. Should 

 this treatment fail to check the progress of the trouble, the formation 

 of pus should be hastened as rapidly as possible. Hot fomentations 

 and poultices are to be constantly used, and as soon as the presence of 

 pus can be detected, the abscess wall is to be opened at its lowest point. 

 In this procedure lies our hope of a speedy cure. As with any simple 

 abscess, if drainage can be so provided that the pus will run off as 

 fast as formed without remaining within the interstices of the tissues, 

 the healing which follows will be rapid and satisfactory. 



Attention is again called to the directions given above as to the 

 necessity of probing the cavity when opened. If upon a careful ex- 

 amination with the probe we find that there are no pockets, no sin- 

 uses, but a simple, regular abscess wall, the indication for treatment 

 is to make an opening from below so that the matter must all escape. 

 Rarely is anything more needed than to keep the orifice open and to 

 bathe or inject the parts with some simple antiseptic wash that is not 

 irritant or caustic. A low opening and cleanliness constitute the 

 essential and rational treatment. 



If the abscess has already opened, giving vent to a quantity of pur- 

 ulent matter, and the pipes and tubes leading from the opening are 

 found to be extensive and surrounded with thick fungoid membranes, 

 there is considerable danger that the internal ligaments or even some 

 of the bones have become affected, in which case the condition has 

 assumed a serious aspect. Or, on the other hand, if the abscess has 

 existed for some time without a rupture, its contents will frequently 

 be found to consist of dried purulent matter, firm and dense, and the 

 walls surrounding the mass will be found greatly thickened. In such 

 a case we must generally have recourse to the application of caustics 

 which will cause a sloughing of all of the unhealthy tissue, and will 

 also stimulate a rapid increase of healthy organized material to re- 

 place that destroyed in the course of the development and treatment 

 of the disease. Threads or cords soaked in gum-arabic solution and 

 rolled in powdered corrosive sublimate may be introduced into the 

 canal and allowed to remain. The skin on all parts of the shoulder 

 and leg beneath the fistula should be carefully greased with lard or 

 oil, as this will prevent the discharge that comes from the opening 

 after the caustic is introduced from irritating or blistering the skin 

 over which it flows. In obstinate cases a piece of caustic potash 



