TREATMENT 91 



aperture through muscle tissue does not drain 

 in the surgical sense. Such an aperture leaks 

 pus but does not drain the cavity dry enougli 

 to serve the purpose for which drainage is 

 needed. It does not matter how many drain- 

 age incisions are made through muscle tissue, 

 the cavitv would still overflow unless the aper- 

 tures are held wide open with a tube. The 

 same may be said of setons. While pus is ab- 

 sorbed by them (in very limited quantities) 

 they do not empty the cavity and are, there- 

 fore, worthless. To heal a wound as large as 

 the one required to expose the diseased part of 

 a fistula of the w^ithers, it is essential that it be 

 kept free from accumulations of its secretions. 



Accidents and Sequelae 



Septicemia is the commonest sequel of the 

 operation. It is predisposed by enfeebled 

 states of the patients but can often be traced 

 to badly directed surgical work. Failure to 

 obey the common laws of modern surgery as 

 regards asepsis is always disastrous in opera- 

 tions of this magnitude, and since this one is 

 performed often in a pus ridden region, dirty 

 internally and externally, and must often be 

 done where conditions are none too favorable, 

 the operation exacts its full toll of fatality 



