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 collapsed 
