90 FISTULA AND POLL-EVIL 



Special Remarks 



Objections have been raised against the use 

 of drainage tubes in the treatment of fistula 

 on the grounds that they are difficult to keep 

 open. This objection we are sure comes from 

 those who have not persevered in their use. A 

 tube long enough to cross the neck and pro- 

 trude no less than eight inches on each side is 

 very easily cleaned without removing it en- 

 tirely, as described above, and after it has es- 

 tablished a good tract for itself it can be taken 

 out entirely for cleaning and can be easily rein- 

 serted. It is essential that a tube be composed 

 of strong material, strong enough to resist the 

 pressure upon it. It must not collapse. A 

 soft tube is worthless. When the strong mus- 

 cles through which it passes press upon it, its 

 usefulness for drainage is destroyed. We, 

 therefore, recommend a stong reinforced rub- 

 ber hose which we perforate with a harness 

 punch (Fig. 6.) 



To prevent drainage tubes from coming out 

 we arm each end with a common twenty penny 

 nail passed across at right angles. A meat 

 skewer or common round stick will also answer 

 the same purpose. 



It seems important to emphasize here the 

 worthlessness of mere incisions through thick 

 muscles as drainage apertures. A collaj)sed 



