FISTULA 7g 



the symptoms differ. But in all cases there is a discharge, 

 either specific in nature, as milk, saliva, urine, faeces, etc., or 

 pus coming from the external fistulous opening termed the 

 mouth of the fistula. This external opening, as a rule, is; 

 funnel-shaped, and either covered with rather large granu- 

 lations or, as the result of the reaction of the scar tissue 

 formed hy the fistula wound, the mouth is puckered. In 

 probing the fistulous canal, a tract of variable length straight 

 or tortuous is detected. The walls of the fistulous canal are 

 either covered with sluggish granulatious or are smooth and 

 tough. As a rule, pain is absent unless a recent inflamma- 

 tion followed by acute cellulitis has set in. 



Outline the treatment of purulent fistula. 



The essential feature in the treatment is the removal of 

 foreign bodies or necrotic tissues. By doing so, the destruc- 

 tive purulent process is stopped, healthy granulating wound 

 surfaces replace the sluggish granulations or indurated walls 

 of the fistulous canal, provided thorough drainage and 

 reasonable antisepsis are established — imperative, whatever 

 method of treatment is employed. 



What two methods may be employed in the treatment of fistula? 

 (1) By escharotics, (3) operative measures. 



Which is the more effective one of the two methods ? 



In the vast majority of cases, direct surgical measures, as 

 the knife, curette, scissors, bone forceps, etc. 



What does the treatment hy escharotics consist of ? 



It consists in the injection of caustics held in solution, in- 

 jected with a view to slough out those agents which interfere 

 With the process of healing, as corrosive sublimate, nitrate of 

 silver, tr. iodine, villate solution, and the more lately intro- 



