534 
M. H. REYNOLDS. 
follows : The separate items used in the order given, once 
daily ; abundant bottom drainage, irrigate thoroughly with 
3 per cent, carbolic acid, or 1-1500 bichloride, rinse out the 
sinuses with pure water, plug the inferior opening and till 
sinuses with a warm aqueous solution of hydrochloric acid 
2 per cent., and any reliable scale pepsin (e.g. Dike’s or Fair¬ 
child’s), 10 per cent., leave undisturbed three hours, remove 
plug and irrigate again with antiseptic solution, to be con¬ 
tinued as seems necessary to secure the desired condition. 
I have records of 20 cases so treated. These show 19 or 
25 per cent, cured, in an average of 36.2 days. The details 
must, ol course, be varied to suit individual cases, and even 
for differing stages in the same case. Larger experience may 
teach that less pepsin is necessary, and that more or less of 
the acid will be more satisfactory. 
Those who have tried this method agree that results are 
more rapid and satisfactory than with the older lines of treat¬ 
ment. There seem to be two objections : First, expensiveness; 
second, patient must be under the immediate care of operator. 
The last can have but little weight because that is where 
every case of fistula should be. 
Cases. —I have full notes on the history and treatment of 
thirteen cases witbf criticisms on my own work, which I had 
hoped to present, but this paper has already reached such 
length that l will give only a few of the most interesting and 
difficult. 
Case A.—Bay horse, ten years old, eleven hundred pounds 
and thin in flesh; had been treated for five years by empirics 
and considered hopeless. An examination April 5th, 1889, 
developed four sinuses with common outlet located as fol¬ 
lows : the first sinus was four inches deep, with an outlet two 
inches anterior to the cervical angles of the scapulas at the 
median line. Probe passed straight down between lamellar 
portion of cervical ligament on one side and rhomboideus, 
angularis, great and small complexus muscles on the other. 
The second was located between the same structures; but 
had its direction backward and downward to anterior border 
of scapula—two and one-half inches long. The third sinus, 
