SETONING 97 



out and washed, and then a little iodoform is dusted over 

 each incision. This washing, cleansing and turning of the 

 tape is repeated daily until its removal. At no time must 

 a seton be allowed to remain in the tissues without being 

 moved for more than twenty-four hours after its insertion, 

 because of the danger of serious infections. Tetanus, ma- 

 lignant oedema and septicaemia, frequent enough sequalse, 

 seldom follow the operation unless the tape is permitted to 

 lie unmoved in the fructuous microbian incubator that t\is 

 subcutaneous seton creates. After, several days there is less 

 danger, because the tissues constituting the boundary of the 

 tract have then protected themselves against the invasion 

 of microorganisms into the surrounding tissues, by the for- 

 mation of an effectual "pyogenic membrane." 



At the end of twelve to fourteen days the tape is re- 

 moved, the tract irrigated with antiseptic water, and the 

 points of exit and entrance are treated with strong astrin- 

 gents to prevent blemishing. Abscesses which may have 

 formed along the tract, and which do not discharge their pus 

 into it, are lanced and irrigated. At the end of twenty days 

 the region is normal and ready for a second operation if nec- 

 essary. 



When setons are inserted for drainage or to prevent the 

 premature healing of chronic fistulae they may be retained 

 indefinitely, but it is advisable to replace the tape with a new 

 one occasionally to prevent undue putridity of the fabric 

 from its constant contamination with the secretions. 



SEQUEL,^. — Setons create a favorable field for the 

 propagation of anaerobic bacteria; the sheltered environ- 

 ment they supply is favorable to bacterial growth. This fact 

 alone is sufficient warning as to the possible dangers of this 

 simple operation, and at once suggests to the operator the 

 importance of inserting only strictly sterilized setons, and 

 only in a field that has been disinfected in no perfunctory 

 manner. The insertion of septic setons and then allowing 

 them to remain unmoved for several days, must be avoided. 

 Despite the fact that a seton tract always becomes infected, 

 which in fact is the desideratum, the infection should be al- 

 lowed to occur only after the tissues have protected them- 

 selves against a spreading of the infective inflammation into 

 the surroundings. The mere presence of the sterilized seton 

 in the tissues stimulates the formation of a barrier against 

 microbian invasion, and the moving of it will prevent the in- 

 cubation of dangerous anaerobic bacteria that may have acci- 

 dentally been drawn into the tract. 



