I s s 



z fiieriiT for not returning w-rits, &c. But tliey mud "be 

 taken off before they are eftreated into the exchequer, by 

 Vnle of court, on good reafon fliewn. IfTues fliall be levied 

 on jurors, for non-appearance ; though on reafonable cxcufe 

 proved by two wicnefies, the juftices may difcharge the 

 ilTues. See Distress, Disthixgas, and Process. 



Issue denotes, in Sur^;ry, an ulcer made dffignedly by the 

 praiSlitioner, and kept open a certain time, or even the pa- 

 tient's whole life, for the cure or prevention of a variety of 

 difeafes. The phyucian, in his praftice, has frequent occa- 

 fion to recommend the making of an iffue, and the furgeon 

 finds it a principal means of rehef in feveral important 

 cafes ; as, for inltance, the white-fwelling, the difeafe of 

 the hip-jeint, caries of the vertebra, S;c. Many perfons 

 -are never in healtli, or at leaft fancy themfelves aUvays ill, 

 xmlefs they have an iiTue in fome part of their body or an- 

 other. Making an iffue, indeed, is not unfreqaently confi- 

 dered as an imitation of nature, who, of her own accord, 

 often forms ulcers in various parts of the body (as is not 

 uncommonly conjectured) for the purpofe of difcharging 

 pernicious humours, wiiereby people are fiippofed to be freed 

 from grievous dilbrdcrs, and have their health preferved. 

 The humoral pathologiils were exceflively partial to thefe 

 notions, which, at the prefent time, wdl be found by 

 every experienced praftitioner to influence the mafs of 

 mankind, and render the formation of ilTues more com- 

 mon than perhaps is confulent wiih the better eltablidied 

 principles of mcilical fcience. Few old fubjefts will al- 

 low a fore of long Handing to be dried up, (as the 

 expreffion is,) without requiring the furgeon immediately 

 afterwards to make an iffue for then-,. When an ulcer has 

 exiiled a great length of lime, the confcitution may poffibly 

 become fo habituated to it, that the health may really fuffer 

 from its being healed. We have often feen ailhmatic com- 

 plaints, and levere head-aches follow the cicatrization of an 

 old ulcer ; but whether they would have happened, if an 

 iifue had been made in time, we caimot undertake to deter- 

 mine pcCtively, though the plan is commendable both as 

 rational and exempt from danger. Whatever may be the 

 fclidity of the theories which have been offered by medical 

 writers in regard to iifues, the prailitioner, v.ho has his 

 eyes open, cannot fail to fee the benefit often derived from 

 fuch means ; and if there be any unquelHonable fads in me- 

 dicine and furgery, we may confidently fet down amongit 

 them the frequent podibility of reheving one difeafe by ex- 

 citing anotiier of a lefs grievous and more curable nature. 



Surgeons of the prefent day have only two ways of making 

 an ifiue ; one is with a lancet, or fcalpel ; the other with 

 cauftic. 



The place for the ilTue being fixed upon, the furgeon and 

 his afliftant are to pinch up a fold of the integuments, and 

 with a lancet, or knife, make in them an incifion of fuffi- 

 tient fize to held * pea, or as many peas as may be thought 

 proper. The pea or peas are t'len to be placed in the cut, 

 ■and covered with a piece of adhefive pkRer, a comprefs and 

 bandage. The peas firil inferted need not be removed for 

 three or four days, when fuppuration will have begun ; but 

 the ifiue is afterwards to be cleaned and dreffed every day, 

 and have frefh peas put into it. The preceding is the ordi- 

 nary method of making fuch iffues as are intended to contain 

 only one or two peas. 



When the iffue is to be larger, which is generally proper 

 in cafes of difeafed vertebrae, white-fweliings, &c. the bell 

 plan is to delboy a portion of the integuments with cauilic. 

 The kali purum, blended with quicklime, is molUy pre- 

 ferred for this purpofe. The fituation and fize of the iffue 



I s s 



having been determined, the furgeon is to take care tliat the 

 cauilic does not extend its aftion to the furrounding part?. 

 With this view he is to take a piece of adhefive plafter, and 

 having cut a hole in it of the exaft fiiape and fize of the 

 ilTue intended to be made, he is to apply it to the part. Thus 

 the plailer will deirnd the adjacent Ikin from the cffecls of 

 the cauflic, while the uncovered portion of integuments, cor- 

 refpcnding to the hole in the plailer, is that which is to be 

 dedroyed. The cauilic is to be taken hold of with a bit of 

 lint or tow, and its end, having been a little moiilcned with 

 water, is to be fteadily rubbed upon the part of the ficin 

 where the iffae is to be formed. The frictions are to be con- 

 tinued, till the whole furface intended to be d;!lroyed ai- 

 fumes a darkifli corroded appearance. The cauilic maItT 

 may now be carefully waihed off with fome wet tow. Tiie 

 plailer is to be removed, and a linfeed poultice applied. As 

 foon 3S the efchar is detached, or any part of it is loofe 

 enough to be cut away without pain dr bleeding, the peas 

 are to be inferted and confined in their proper place with a 

 piece of adhefive plafter. Some ufe beans for the purpofe ; 

 others beads, which anfwer very weW, and have the advantage 

 of ferving for any length of time, when wafiied and cleaned 

 every day. If the iffue is at all of a longitudinal fiiape, the 

 peas, beans, or beads may be more eafily kept in their places 

 when ftrung upon a thread. 



Iffues ought always to be made, if pofiible, in a fituation 

 where the peas will not be much difturbed in the ordinary 

 motions of the body, nor interfere with the aftions of the 

 mufcies. The interfpaces between the margins and infer- 

 tions of mufcies are deemed the moft eligible places. Thus, 

 iffues in the arm are ufually made jull at the inferior angle 

 of the deltoid mufcle, by the fide of the external edge of 

 the biceps. In the lower extremities iffues are often made 

 at the inner fide of the thigh, immediately above tlie knee, 

 in a cavity readily L'lt there with the fingers. Sometimes 

 ilfues are made upon the infide of the kg, juil below the 

 knee. The nape of the neck is a common place for them. 

 In caries of the vertebra; they are made on each fide of 

 the fpinous procefTcs. In difeafed hips they are formed in 

 a deprefTion juil behind and b-low the tiochantcr niaj.ir. 

 When the nature of the cafe does not fix the iiluation of 

 an iffue particularly, the arm fhould be preferred to the 

 leg, as iffues upon the upper extremity, cfpecially the left 

 arm, are much lefs annoying than upon ei:her of the lower 

 limbs. 



The great art of keeping an iffue open for a long whiiei 

 is always to maintain an equal and eifeclual preffure upon 

 the peas, by which means they will be confined in their 

 places, and the granulations hindered from rifiag. Coni- 

 preffes of pafleboard and fheet lead will often be found 

 highly ferviceable. 



IS-SUR-TILLE, in Geography, a town of France, in the 

 departmer.t of the Cote d'Or, and chief place of a canton, 

 in the dillrift of Dijon ; 4 miles N. of Dijon. The place 

 contains 1598, and the canton 10,170 inhabitants, on a 

 territory of ^jj kiliometrcs, in 23 communes. N. Lit. 

 47" 3 y. E. long. 5 9'. 



ISSUS, in Ai.c'unt Geography, a town of Afia, in Gili- 

 cia, fituated on the fea coafl. This town was large, rich, 

 and populous. It is famous for the battle fought by 

 Alexander in the year 335 B.C. in v.-h.ich lie defeated the 

 Pcrfians, and took as prifoners the wife, motlier, and 

 daughters of Darius. 



ISSY l'Eveque, in Geography, a town of France, in 

 "the department of the Saone and J-.oirc, aixl chief place of 



a cantoi}} 



