CHAPTER \T, 



SETONING. 



In certain conditions it used to be, and to some extent still is. the 

 custom to set up chronic inflammation and suppuration under the 

 skin in order to influence processes going on in the neighbourhood. 

 For this purpose setons consisting of a broad piece of tape or cord 

 of plaited horsehair are passed beneath the skin by means of special 

 instruments. 



Although active inflammatory processes in the skin certainh' 

 appear to affect the condition of deep-seated tissues, this action 

 is probably not so important as is believed, and when visible im- 

 provement occurs one is not without a suspicion that the indispensable 

 rest has pla3'ed an important part in producing the result. Blisters 

 achieve somewhat similar results without leaving the mark which 

 always occurs to a greater or less extent after setoning. The use 

 of setons to eftect healing of abscesses and ha;matomata was 

 frequent in former times. Inasmuch as healing may be produced 

 much more rapidly and satisfactorily by opening the haematoma at 

 the deepest point and applying steady pressure, the use of setons 

 for this purpose is not to be commended, nor is it any more 

 advisable in the treatment of sinuses, because it does not prevent 

 the continued formation of pus nor the extension of chronic in- 

 flammatory processes or necrosis in the deep parts, without which 

 the sinus would heal of itself. Such canals may be much better 

 and more rapidl}' dealt with by direct operation and the removal 

 of all diseased tissue by the curette. For these reasons the employ- 

 ment of setons has greatly diminished, and, inasmuch as their use 

 invariably entails prolonged rest, there is always some reason for 

 casting doubt on its direct beneficial result. As, however, opinion is 



