196 INJURIES. 



established the evacuation of the pus should be determined on. 

 And, generally speaking, that part should be chosen for punc- 

 ture where the pointing exists. 



The abscess opened, our next duty is to ascertain the 

 state of its interior. We shall probably find sinuses deep 

 and devious, or a space of some sort made by the lodgment 

 of matter. At one time I had considerable practice in these 

 cases, and I must acknowledge to being a very unsuccessful 

 practitioner until the scalpel was freely handled, after which 

 I became altogether fortunate in my results. On numerous 

 occasions I tried injections and dressings of all descriptions 

 without success, though 1 afterwards effected a cure simply 

 by laying open the cavity and leaving it without anything 

 further, beyond dressing the parts every second, third, or 

 fourth day with some digestive. My father was so assured 

 of the benefit gained by this practice, that he was wont to 

 exclaim, after laying open the sinuses, '^ Now the disease is 

 cured/'' ^ 1^'rom the direction of the sinuses, or from the 

 thickness of the parts to be cut through, it is, however, not 

 always prudent to pursue this practice. Where incisions 

 cannot be attempted, we must endeavour to establish a 

 counter- opening J or to make an aperture through the side of 

 the tumour in such direction as to pierce the bottom of the 

 sinus, thus giving easier vent to the collected matter. 

 Should we be able to run setons through the fistulous canals, 

 it will not only keep the apertures open, but will be found 

 very serviceable in promoting healthy granulation. When 

 the scapula or its cartilage intervenes, however, this will not 

 be practicable. Any carious bone, cartilage, or ligament, 

 there may be should however be removed. In fine, the case 

 must in these respects be treated as poll-evil. 



Pressure. — Surgeons treat fistulas hj pressure ; the ob- 

 ject being to force the sides close, with a view to adhesion. 



' Sinuses may be laid open by incisions from within. The cuts are made with 

 bistouries of different kinds. The sharp-pointed bistoury, with a director, will 

 be found useful : though, in other cases, the probe-pointed instrument is con- 

 venient. To some cases, the bistoure cache seems best adapted. This, however, 

 must be left to the discrimination of the operator. 



