Bismuth paste in chronic suppurations, its diagnostic importance and therapeutic value . shown in Fig. 1, filled withthe paste, is then immersed in hot water, so as to keepthe paste liquid. The tip of the nozzle is placed againstthe opening, and with steady, gentle pressure the pasteis injected into the sinuses until the patient feels somedistention. No force should be used. In order to as-certain whether the external sinus communicates withthe rectum, the finger should be introduced, and, if itshows traces of the paste, we may conclude that we aredealing with a complete fistula. Should this b
Bismuth paste in chronic suppurations, its diagnostic importance and therapeutic value . shown in Fig. 1, filled withthe paste, is then immersed in hot water, so as to keepthe paste liquid. The tip of the nozzle is placed againstthe opening, and with steady, gentle pressure the pasteis injected into the sinuses until the patient feels somedistention. No force should be used. In order to as-certain whether the external sinus communicates withthe rectum, the finger should be introduced, and, if itshows traces of the paste, we may conclude that we aredealing with a complete fistula. Should this be the case,the treatment will be somewhat difficult. It is then nec-essary to occlude the internal opening of the fistula with KKCTAL FISTULAE. 127 the finger while the paste is being injected into the external opening. Thus the escape of the paste into the rec-tum is prevented and it is forced into the other direction,where it will fill other existing channels. At times itbecomes necessary to employ a rectoscope in order to in-ject the fistula through the opening within the Fig. 50. Method of injection of external rectal fistula. For this purpose the long nozzle of the metal syringe isused. It must be kept warm, so that the paste will notsolidify and clog the narrow channel. When the fistulahas a very small opening and is in the puckering folds ofthe anus, the spear-shaped tip is to be inserted, while anassistant stretches the folds. Fig. 50 illustrates this pro-cedure. 128 BISMUTH PASTE IN CHRONIC SUPPURATIONS. After the injection is completed, a T-bandage is ap-plied and the dressing changed daily. If after one weekthe discharge continues to be purulent, the fistula shouldbe reinjected. If the secretion becomes serous, it shouldnot be reinjected, as it will usually close within a shortperiod. Fig. 50 illustrates the procedure.
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