FISTULOUS WITHERS. 
299 
with the exception of a small opening of the size of a quill, from 
which there is still a discharge, evidently from the diseased bone. 
I remain, my dear Sir, 
Your most obedient servant, 
James Tindal, V. S. 
February 26, 1839. 
REPLY. 
Dear Sir, 
I am afraid that, in the case you refer to, I shall be unable to 
render you much assistance after what you have already done, 
further than to suggest a repetition of the operation. Before this, 
however, I would try the effect of some injection well forced into 
the sinus with a syringe. For instance, you might take a solution 
of corrosive sublimate, in the proportion of seven grains to the ounce 
of water, and inject it once or twice a day for a few days. If there 
is no appearance of improvement, increase the sublimate to ten 
grains. An injection of tincture of cantharides might be worth a 
trial for a few days, or a little muriatic acid much diluted with 
water. 
If you suspect that a portion of the bone may be still diseased, 
and the sinus is not so deep but that you can reach to the bottom 
of it, a small piece of caustic potass, or lunar caustic, may be in- 
troduced and immediately withdrawn. Even sulphate of copper 
may be used in the same way, and has often good effect. 
I am afraid that there is something at the bottom of the sinus, 
which must be got rid of — perhaps a little bit of carious bone, or a 
loose piece of cartilage or ligament, or else the orifice is not depen- 
dent, or the seton has not passed through the lower portion of the 
sinus. Sometimes the washing out of the sinus by the injection of 
warm water brings away any loose bony or other matter. 
Have you tried the effects of pressure, or can it be done, so as 
to compress the whole course of the sinus 1 A splinter sometimes 
enables this to be effected. Exercise should not be taken if it 
can be prevented, as the play of the parts may prevent adhesion. 
You do not mention where the present sinus opens. 
If it should be necessary for you to open the wound afresh, you 
must endeavour to excise every portion of bone that is diseased. 
A small saw, not exceeding two inches in length, would probably 
effect this. If every diseased or loose portion can be removed, it 
is most likely that the parts will heal up at once as a simple 
wound. If the bone should prove to be not diseased, a blister 
might be serviceable. W. D. 
