’ FISTULA, 117 
Vv. 
FISTULA. 
Modern classifications of fistule are based upon the etiology, patho- 
‘geny and anatomo-pathological characters of these lesions. We have 
congenital and pathological fistule, also fistule from want of cicatrt- 
zation and those from defective cicatrization. The most common con- 
genital fistule are those of the umbilicus, the urethra, and those 
which establish a communication between the rectum or the bladder 
and the vagina. Pathological fiistule include numerous varieties. We 
‘find the zxcomplete, blind, or non-communicating, and the complete or 
communicating fistule. Blind fistula are called ¢dzopathic when they 
follow abscesses ; symptomatic when they result from other lesions; 
‘they are externally blind when they open on the skin; éuternally blind 
when on the mucous tegument. Communicating fistule include: 1. 
Serous fistula, which open deep down in one of the large visceral 
cavities, in an articular or tendinous synovial sac, or in a natural or 
accidental subcutaneous bursa; 2. Mucous fistula, which open in a 
reservoir or in a excretory canal. Generally, complete fistulae are 
cutaneous and mucous; one of their openings is on the skin, the other 
on a mucous membrane; they may be dz-mucous or bt-cutaneous when 
they have two openings on those membranes. 
The therapeutics of fistulz include numerous methods or means, which 
have their special regulations. It is plain that lesions, so various as to 
nature and origin, will require different kinds of treatment. Sympto- 
matic fistule do not demand the same care as idiopathic fistule ; with 
fistula which opens in serous cavities, it would be dangerous to inter- 
fere as it is ordinarily done with those which open on a mucous mem- 
brane or in an excretory canal; many of the latter require a special in- 
terference. 
Idiopathic purulent fistula, often kept up by the peculiar condition of 
their walls, by the atony of their granulating layer, sometimes by the 
sinuosity of their course, by the existence of subcutaneous or intra- 
muscular undermining, or by the excessive mobility of the organic 
layers of the region where they exist, do not resist a:local energetic 
treatment. One may recognize the nature of the persistence of the fis- 
tulous tract by the more or less marked tumefaction of the region, the 
quantity and the quality of the pus, and by exploring the tract. If it 
be due to an undermining and kept up by frequent motions of the part, 
‘one may, after thoroughly washing the cavity, attempt a cure by pres- 
‘sure and immobilization of the region. But often the undermining ex- 
4 
