Issues may be made by caustic, or by incision, or by the actual cautery, that is, by burning with a red-hot iron. The first may be made either by rubbing a portion of skin of the requisite size with the Caustic Potash, or by making a paste of equal parts of the Potash and soft soap, and laying it on the skin till the latter is converted into a black slough. Before applying the Caustic, the skin in the neighbourhood should be protected with a piece of sticking plaister, having a hole cut in the centre, the size that the sore is intended to be. After the application of the Caustic, the part should be poulticed till the slough separates, and then the sore may be prevented from healing, either by keeping a large pea always bound on the sore, or by touching it occasionally with caustic.

The second way is to pinch up the skin, and slit it open with a lancet, and then introduce peas to prevent its healing.

Issues should never be made over projecting points of bones, or over the bellies of muscles, for they might degenerate into most obstinate sores.

The Actual Cautery, although it has a barbarous look about it, is not by any means the most painful way of making a sore; and its effects are speedy. It is easily effected by means of an iron rod with a knob of the size and shape of an olive at one end of it, and a wooden handle at the other. The knob being heated red hot, is rubbed on the skin so as to make two or three blackened lines. Then the cold water dressing or a poultice may be applied till the scabs fall off. The hotter the iron the less pain it gives.