68 FISTULA AND POLL-EVIL 



It does not matter whether the condition has 

 been caused by an abrasion or has originated in 

 li cyst of the dorsal bursa, procrastination is 

 inadvisable. 



We have found, however, in the cases of typi- 

 cal fistulse that the evacuation of the contents 

 of the sac one week before the radical operation 

 is performed, is good practice, because it forti- 

 fies the tissues against post-operative infections 

 of a grave character. Where strict aseptic con- 

 ditions are maintained in the operation and 

 the patient has skillful after-care, this precau- 

 tion is not as essential as when careless methods 

 prevail or when the after-care must be con- 

 signed to untrained hands. 



It is, therefore, recommended, as a routine 

 measure in field practice, to lance the cyst, 

 evacuate the liquid and flocculent contents and 

 then submit the sac to casual irrigations one 

 week to ten days before operating. 



In the case of old fistulee originating as 

 cysts and which have become infected from 

 any source or in the traumatic variety having 

 either superficial or deep pus accumulations, 

 lancing one week before operating is likewise 

 helpful in that surgical shock is modified and 

 there is less soiling of the surgical wound with 

 pus during the operation. 



These suggestions need not be laid down as 



