E. Probably Cassia lignea, or in rolled up bark like twigs, to distinguish it from the drug called Cassia fistula.

With the patient thus secured we first of all ascertain by means of the probe whether or no the non-healing of the wound is due to the presence of a fistula.

A fistulous wound of the foot in which the lower and blind end of the fistula is situated below the level of the coronary margin of the wall.

Even when an opening has already occurred on the coronet, the same condition of sub-horny suppuration may be met with in cases when the opening of the fistula has by some means or other become occluded.

Granulation tissue, for instance, may have temporarily closed the mouth of the fistula.

Unless there has been discovered a fistula, which on probing is seen to lead direct to the position in which we know the cartilage to be, we know of no precise means by which the existence of this condition may be diagnosed.

The mouth of each fistula is generally filled with a mulberry-like granulation tissue, standing above the level of the skin, and bleeding easily if touched.

Should the mouth of a fistula become occluded with the granulations filling it, and the discharge prevented from escaping, it soon happens that we have close to the fistula that has closed a tender fluctuating swelling.

Should the mouth of a fistula become occluded with the granulations filling it, and the discharge prevented from escaping, it soon happens that we have close to the fistula that has closed a tender fluctuating swelling.

The formation of the abscess, the after-discharge of its contents, and the final establishing of a fistula, are processes greatly prolonged in this form of quittor.

We have, in fact, seen many cases where this treatment was adopted prior to the formation of a fistula, and also in cases where one or more fistulous openings already existed, where repeated blisters to the coronet have alone been sufficient to effect a cure.

What happens now, of course, is that an intense and acute inflammation is set up along the whole track of the fistula, in which position the inflammatory changes were heretofore chronic.

It is then conveniently inserted into each fistula.

Almost immediately after its introduction into the fistula there is formed about it an almost impermeable layer of a metallic albuminate, which effectively prevents further rapid action of the caustic.

Again, careful though we may be with the probe, it is extremely difficult to be certain that we have discovered the whole extent of any fistula.

An equal difficulty, therefore, exists in being certain that we have placed the caustic in the position in which it is most wantednamely, at the furthermost end of the fistula where the necrotic tissue is to be found.

Although Villate's solution or any other caustic used in the manner we have described often effects a cure, many practitioners insist on the fact that a counter-opening to the fistula must also be made.

The probe is used and the direction and depth of the fistula ascertained.

The cavity of the fistula is then opened up with a scalpel, and every particle of diseased tissue removed with this instrument and a pair of forceps.

If, in spite of the antiseptic irrigations, the fistula persists, then nothing remains but to resort to excision of the aponeurosis, as described on p. 222.

The base of the wedge-shaped portion removed contains the opening of the fistula, and the apex of the wedge should reach to the bottom of the sinus (see Fig. 142).

a, The opening of the fistula.]

In connection with tendinous quittor, when septic matter has gained the sheath of the flexor tendons, there is, for a long time after healing of the fistula, a marked tendency for the animal to go on his toe.

Finally it breaks at one or more spots, and there exudes from the opening or openings a purulent and oftentimes sanious discharge, which coagulates about each fistula after the manner of ordinary synovia.

O mihi tum quam molliter ossa quiescant, Vestra meos olim si fistula dicat amores!