. Modern surgery, general and operative. irrigate the wound with salt solution, pack firmly with iodoformgauze to prevent oozing, and dress with gauze and a T-bandage. The packingis removed in twenty-four hours unless it is soiled earlier, in which case it ispromptly removed. After twenty-four hours the wound is irrigated and packedlightly with gauze to its full depth. This dressing should be repeated everyday and any bridging of the tissues should be broken down by a probe. Ifthe wound becomes sluggish, it is stimulated with nitrate of silver and sodiumiodid is given in small doses three time
. Modern surgery, general and operative. irrigate the wound with salt solution, pack firmly with iodoformgauze to prevent oozing, and dress with gauze and a T-bandage. The packingis removed in twenty-four hours unless it is soiled earlier, in which case it ispromptly removed. After twenty-four hours the wound is irrigated and packedlightly with gauze to its full depth. This dressing should be repeated everyday and any bridging of the tissues should be broken down by a probe. Ifthe wound becomes sluggish, it is stimulated with nitrate of silver and sodiumiodid is given in small doses three times daily. The bowels should be moved after forty-eight hours by enema. The dietshould be light and fluid for the first few days after operation, and the bowelsshould not be restrained by drugs. Get a tuberculous patient out of bed assoon as possible. If there are two fistulae, cut one through, and when onewound has healed, cut the other. Some straight sinuses can be extirpatedand the parts sutured, primary union occasionally 1314 Diseases and Injuries of the Rectum and Anus If a blind external fistula does not heal, every sinus must be incised, andthickened walls must be cut away or scraped away. In a blind internal fistula an external incision is made to convert the caseinto a complete fistula, which is then treated as directed above. In horseshoe fistula more than one operation may be necessary in orderto avoid cutting the sphincter muscle twice in one operation, a proceedingwhich would probably lead to fecal incontinence. One side alone is operatedon at one seance. Sinuses are opened and scraped, the sphincter is divided,the angles and edges of skin are trimmed away, and the wound is the wound is healed, or nearly healed, the other side should be operatedupon. Any operation will fail if it is not done thoroughly. Operative failure iscommon after fistula operations. The operation described above usually givesexcellent results in simple fistula. It giv
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