In fact, by defining quittor as a 'fistula,' or little pipe, we have ourselves already indirectly restricted the use of the word to the two latter conditions, for in those varieties known as Simple or Cutaneous and Tendinous, the wound is generally broad and open, or, at any rate, superficial, and can scarcely be strictly described as 'fistulous.'

In the two latter, however, a true fistula exists.

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.

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.

Upon the swelling is seen the mouth of the fistula, or it may be the mouths of several, and from them all a discharge of pus.

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.

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.

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 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.

This, if a fistula is present, may be best done with a blunt-pointed bistoury, or with a cannulated director and a scalpel.

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.

A probe is now inserted into the opening at the coronet, and the direction of the fistula noted, after which the foot is firmly secured, and an Esmarch bandage and tourniquet applied to the limb.

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).

After the horn is removed and the fistula followed up, it is sometimes found that what we at first thought was its end, it may now be continued in an altogether different direction.

a, The opening of the fistula.]

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.

Just listen: "'Surge meo Domno dulces fac, fistula versus: David amat versus, surge et fac fistula versus.

Just listen: "'Surge meo Domno dulces fac, fistula versus: David amat versus, surge et fac fistula versus.

Dulcis amor David inspirat corda canentum, Cordibus in nostris faciat amor ipsius odas: Vates Homerus amat David, fac, fistula, versus.

Alston says that the "Cassia lignea of the ancients was the larger branches of the cinnamon tree, cut off with their bark and sent together to the druggists; their Cassia fistula, or Syrinx, was the same cinnamon in the bark only;" but Ruæus says that it also sometimes denoted the lavender, and sometimes the rosemary.