336 RADICAL CURE OF FISTULA : [BOOK II. 



After having found all his efforts useless, the 

 practitioner will change his plan, and force the 

 matter to escape as soon as may be : for the dis- 

 order is every hour extending its baleful influence. 

 For this purpose the knife is to be employed when 

 the tumour is sufficiently ripe, which is a state it may 

 be brought to, by means of the poultice application. 

 Of these, two or three kinds were prescribed, with 

 the method of fastening them on, but in this latter 

 respect, a material difference arises in consequence 

 of the different shape of the parts. The bandage 

 in this case must be allowed to come farther back, 

 and be there detained by tying the tapes short be- 

 hind and lengthening the front ones. See figure at 

 page 325. 



Fomentations of warm water, in which cloths 

 have been steeped, slightly wrung out and applied 

 to the parts, will be found highly serviceable, and 

 may precede the application of poultice. When 

 by these means the tumour appears ripe, open the 

 most prominent part with lancet or bistoury, and 

 insert a whalebone probe to ascertain the direction 

 that the fistulous sinuses or pipes extend, in order 

 that these may also be laid open, and the whole 

 matter suffered to escape. In some cases a stiffer 

 and larger probe may be employed, and when a sinus 

 lies favourable, introduce the probe to the bottom 

 and cut down upon it, its whole length. But as to 

 the lowermost sinus, when it tends towards the 

 shoulder, so as to interfere with the action thereof, 

 the knife is not to pass through it, but a seton is to 



