Bismuth paste in chronic suppurations, its diagnostic importance and therapeutic value . patient is only 23 years old andweighs two hundred and sixty pounds. For the past five years hehas had a foul discharge from four little openings, one-half inch apart,in the fold above the anus. The first injection proved that they com-municated, because the paste injected in one at once escaped from KKCTAI, I1ST I I,A i;. 129 the mouths of the others. At one time a small quantity of jot-blackhairs came out of one of the openings. This indicated that we hadto deal with a dermoid cyst, and consequently an o
Bismuth paste in chronic suppurations, its diagnostic importance and therapeutic value . patient is only 23 years old andweighs two hundred and sixty pounds. For the past five years hehas had a foul discharge from four little openings, one-half inch apart,in the fold above the anus. The first injection proved that they com-municated, because the paste injected in one at once escaped from KKCTAI, I1ST I I,A i;. 129 the mouths of the others. At one time a small quantity of jot-blackhairs came out of one of the openings. This indicated that we hadto deal with a dermoid cyst, and consequently an operation was ad-vised and performed, which consisted in the complete eradication ofthe cyst. The cavity was drained and four days later an injection ofthe paste was made. The purulent and foul discharge changed intoa yellowish, clear serum within three days, and healing progressedrapidly. This picture shows that a greater part of the incision ishealed, and that the paste injected through the upper opening escapesthrough the lower. Within a period of six weeks the sinuses Pig. 52. Supposed rectal fistula, shown to be a sinus resulting from disease ofpelvic organs. A, fistulous opening in the rectum ; B, bi-paste in the pelvic cavity. The following case is typical of those in which incor-rect diagnosis led to futile operations: Rectal Fistula Originating in the Pelvis.—The patient, a lady, aged30, has since 1900 undergone six operations for rectal fistula, all ofwhich failed to stop the profuse and irritating pus discharge. The lastoperation was very extensive and produced incontinence of feces. Inthis condition the patient came to me in January. 1908. when I madethe first bismuth paste injection. A radiograph (Fig. 52) disclosed thatthe fistula had its origin high up in the pelvis. Several sinuses as highas the sacral prominence are plainly shown, the early discovery ofwhich could have saved the patient the six operations and nine years 130 BISMUTH TASTE IN CHRONI
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