LESrONS OF THE PAROTID DUCT. 
353 
violent inflammation of the parotid. To avoid this, Desault re- 
commended compression on the gland itself, in order to dry it up, by 
atrophizing the sources of the salivary secretion. His proceeding, 
as well as that of Maisonneuve, — which, as we have already 
stated, consisted in establishing a compression on that part of the 
canal intermediate between the gland and the fistula,— »was attended 
with bad results. Louis, Duphenix, Malgaigne, and Velpeau, re- 
jected it, as frequently producing very serious disorders of the 
glandular tissue. 
3d. The twisted suture has, according to the account of numerous 
surgeons, and especially of Percy, produced a cure in a very few 
days when applied to a fistula of recent date. 
B. — The second method proposes to dilate the natural conduit of 
the saliva. Morand was the first, person who practised it. It 
consists in introducing a stylet, furnished with a treble thread, 
through the exterior opening of the duct which is directed towards 
the mouth, following the course of the canal. Arrived at this 
point, the surgeon unrolls the thread, and ties the end of the little 
seton which comes into the mouth to the one which was left float- 
ing from the exterior opening, forming with the two ends a small 
knot on the cheek. On the following day he introduces a rather 
larger seton in a similar manner, and continues, from day to day, 
gradually to increase its size until the saliva passes into the mnu h, 
and the ulcer becomes sufficiently diminished. He then takes out 
the seton, or rather, he draws it gently towards the mouth, so as to 
leave but a very short end at the bottom of the fistula, and one 
which does not pass through the external wound. The knot is not 
taken away until the fistula has become completely dried up by 
means of repeated cauterizations and desiccative applications. 
This operation of dilating the natural conduit is not always 
practicable. On the contrary, it frequently happens that, at the 
period the surgeon is called in, it is impossible to discover the 
anterior end of the divided canal, which, not unfrequently, has been 
obliterated for a considerable time. It then becomes necessary to 
have recourse to a new operation in order to establish a new 
passage. 
C. — This third method comprehends a great number of different 
courses of proceeding. Since the time of Deroy, who made use 
of a heated iron to perforate the cheek and obtain a fresh passage, 
almost all the surgeons who have been called upon to treat ls'ulse 
of this nature have introduced some modification in the kind or form 
of the instruments. Duphenix made use of a long, straight bistoury; 
Monro of an awl ; and Desault of a hydrocele trocar, &c. All these 
various modes of proceeding, and others that we shall pass o\/er m 
silence, had for their aim the formation of a canal calculated to re- 
