OPERATION FOR ILIAC FISTULA 337 



every second day at least, and the bone cavity and tracts sub- 

 mitted to a good cleansing with the copper sulphate solution. 

 When the eschar has sloughed off the walls are re-seared, 

 to retard the too rapid healing of the wound. This burning 

 is repeated three or even more times, each of which finds the 

 growth smaller. When the physiognomy of the region 

 seems to indicate that the growth is disappearing, and the 

 discharge from the sternum has ceased, the treatment is dis- 

 continued and the wound is allowed to close. 



Operation for Iliac Fistula. 



INDICATIONS.— By "iliac fistula" is meant fistula in 

 the region of the external angle of the ilium. This fistula is 

 always due to fracture of the ilium. Segments of bone 

 broken from the angle, or the whole angle when broken from 

 the main body, are often drawn downward by the muscles 

 attached to them, and as the accident is always attended with 

 considerable bruising of the soft tissues and the influx of 

 more or less blood and serosity, a favorable field for inflection 

 is at once created. An abscess forms, points or is lanced, but 

 the, orifice does not heal. On the contrary, it continues to 

 discharge or may apparently cicatrize only to point again, 

 until finally its chronicity is well established. The bone, 

 contrary to expectations, does not die and separate from the 

 soft tissues, but instead tends to grow larger by the activity 

 of its still well nourished periosteum, and to become more 

 firmly fused with a mass of connective tissue. Behind this 

 mass a pus cavity has formed, and in a position contiguous to 

 the abdomen where it can not be easily managed. In fact, 

 a chronic fistulous condition of the most obstinate and inac- 

 cessible order has been established. The pus sac locates 

 itself either behind the segment adjacent to the abdominal 

 parietes or else along the shaft of the ilium near the coxo- 

 femoral articulation. In either case it is not an inviting loca- 

 tion for radical intervention. 



Simple iliac fistuhe may be due to the existence of a well 

 separated sequestrum adjacent to the angle, in which case 

 incision and abstraction with forceps is immediately followed 

 by cicatrization, but this is a minor affair as compared with 

 the case in which a large segment of viable bone and the 

 mass of fibrous tissue with which it surrounds itself, form the 

 outer wall of the abscess cavity and whose inner wall is re- 

 lated closely to the abdomen. 



TECHNIQUE. — There are two courses that may be 



