FISTULA OF THE COLON FOLLOWING ENTEROTOMY. 
173 
spite of the loss of chyle began to lay on flesh. Blistered around 
the opening with the idea of causing enough swelling to close it ; 
budded with hot iron three times, blistering on top of that; tried 
Squib’s flexible collodion to close opening, which had closed con¬ 
siderably since the blistering, &c., but still persisted ; not the 
slightest good. Applied adhesive plaster, same result; silver 
wire deeply through the edges, with no snccess. Before each 
fresh measure was tried I scarified the walls of the fistulous tract 
as deeply as possible until the blood was drawn, to expose a 
granulating surface. The patient had now been laid off work for 
nearly three months, and after these various fruitless attempts, I 
made up my mind to make a deep incised wound, and trust to an 
obliteration of the upper part of the tract in the resultant granu¬ 
lation. To run the risk of rupture by laying the fistula open to 
the bowel was too rash a procedure for any one to undertake, 
especially as its course through the muscles was of such an extent. 
Cast animal on near side, and made an oblique incision about five 
inches in length and one and-a-half inches in depth, in line from 
the anterior spine of ilium downwards and forwards, opening up 
the upper part of the tract in incision. Next inserted silver wire 
sutures, as deeply as possible and very close together, and drew 
the lips of the wound in firm opposition. Used a large curved 
needle, similar to the one used on the human perinaeum. This 
operation had the desired effect, and although of course the lower 
part of the fistulous tract is still in direct communication with the 
bowel at the time of writing, June 15th, the upper is completely 
obliterated, and the only thing to be seen of this exceedingly 
unpleasant and troublesome sequel of enterotomy is a slight scar 
which shows the line of the incision. I might also state 
that several medical men saw the case and were greatly in¬ 
terested ; they advised pressure, the mild use of nitrate of silver 
as in the vesico-vaginal fistula of woman, both of which modes of 
treatment I forgot to say I gave a thorough trial, but they proved 
of not the slightest avail. Bectal alimentation for several days 
to give the tract a better chance to heal, by withdrawing the 
source of irritation, the chyle, suggested itself to me; and if my 
incision failed in its object, I would have laid it open afresh, and 
