no matter what procedure is
adopted; the greater the constitutional derangement and the poorer the
general health, the longer is the cure delayed. The great secret of our
success in treating this disease consists in applying appropriate
constitutional treatment at the same time.

The use of the knife is becoming obsolete, and has, to a great extent,
given way to other measures which are equally successful. Indeed, other
means will succeed in cases in which the knife fails or is for any
reason inapplicable. One great objection to the knife is not only the
dread which patients entertain of it, but the great liability of its use
to result in paralysis of the sphincters of the anus, the consequence of
which is loss of control over the bowels; and another is that it
sometimes entirely fails to result in cure. By the means which we
employ, these objections are entirely overcome, and, while the general
system is being renovated, the fistula is healed, without any
complications.

Fistula is much more common than has generally been supposed. It is apt
to be associated with pulmonary diseases. Heretofore, it has been
supposed that to heal the fistula, during the progress of the lung
affection, would result in fatal consequences, and the patient has been
left to suffer and die under the combined influence, of the _two_
diseases. Observation, based upon an extensive experience in the
management of such diseases, has proved that supposition to be
fallacious in every respect, and we would urge all persons afflicted
with fistula to have the affliction cured, no matter what complications
may exist. The fact underlying this erroneous opinion is, that when
grave constitutional troubles have co-existed the use of the knife has
resulted in failure, and the fistula has refused to heal.

Having had ample facilities for observing the relative merits of the
various methods of treating this complaint, in hundreds of eases, in our
own practice and that of others, we feel justified in saying that the
plan which we have adopted is far superior to that in general use. The
local treatment which we employ depends upon the nature of the fistula;
in some instances the ligature is best, in others caustics, and again
injection, etc., while still others require a combination of two or more
methods, or a modification of them.

In cases in which it is impossible for the patient to come to our hotel
for a radical and speedy cure of the fistula, we employ