5. Great Care Is Necessary In Healing An Issue Or Seton When Once Established

It should never be done suddenly.

3179. Therapeutic Uses

In Chronic Pulmonary Affections, particularly in Asthma, Angina Pectoris, Chronic Bronchitis, and Catarrh, an issue at the nape of the neck is often effectual in mitigating or removing the symptoms. In Phthisis, caustic issues immediately below one or both clavicles, even when the disease has far advanced, have been warmly advocated by M. Bricheteau.* Dr. Gravest thinks highly of setons in the same position, in incipient Phthisis.

3180. In Chronic Laryngitis, a seton or issue at the upper part of the chest is advised by Dr. Williams.

3181. In Chronic Inflammation of the Heart or its Membranes, much relief is obtained from the use of an issue in the prAecordial region. Violent Palpitations, consequent on the healing of an old ulcer or long-established cutaneous disease, often disappear under the establishment of a seton or issue, near the seat of the original disease.

* Med.-Chir. Rev., vol. lx. p. 599. Clin. Lect., p. 104.

Lib. of Med., vol. iii p. 50.

3182. In Some Chronic Cerebral And Spinal Affections, They Prove Most Useful

Where there exists a pre-disposition to Apoplexy, an issue at the back of the neck is sufficient to ward off an attack. This is shown by the fact, that the sudden healing of an artificial or natural issue has been followed by its appearance. (Prichard.*) The remark is equally applicable to Paralysis. A long issue or seton applied to different parts of the spine has sometimes been found beneficial in Paralysis Agitans. Headaches of the most obstinate character, occurring in robust subjects, will often yield to an issue at the nape of the neck.

3183. In Plethora, and in Epilepsy connected with Plethora, issues or setons at the nape of the neck often mitigate the severity of the symptoms, in a remarkable manner. Their benefit, however, is far from uniform.

3184. In Many Chronic Affections Of The Eye, These Agents Are Of Great Service

In Chronic Opacities of the Cornea, Mr. Law-rence advises, after other remedies fail, the establishment of an issue or seton on the temple. In Chronic Strumous Ophthalmia, an issue on the arm is recommended by Mr. Welbank. In Amaurosis following the healing of an old Ulcer or Cutaneous Eruption, the plan that has been found the most successful is counter-irritation by means of an issue or seton. (Middle-more. ) In Ulcers of the Cornea, Mr. Critchett§; states that he has seen issues, inserted into the temple and kept there for months, of the most essential service.

3185. In Subacute and Chronic Dropsy, the establishment of an issue has occasionally been found of great benefit; but much discrimination is necessary in selecting the cases in which it is likely to prove useful. Dr. Copland || advises that the issue should be inserted on the side opposite to that where uneasiness is complained of, or at some distance from the most affected part. In Anasarca depending upon, or connected with, Disease of the Kidneys, Dr. Venables¶ found great benefit from an issue on the loins, cupping in that region being employed at the same time. Dr. Prout found the same measure of great service in the Chronic stage of Granular Disease of the Kidneys. Much benefit has also been found to follow the insertion of an issue on the chest in Hydrothorax and Hydropericardium. The best locality for it, in those cases, is the margin of the false ribs. In Ovarian and Encysted Dropsy, setons or issues have been advised, but their utility is very doubtful.

* Cyc. Pract. Med., vol. ii. On Diseases of the Eye, p. 371. On Diseases of the Eye, vol. ii. p. 279.

§ Lancet. July 15, 1854. || Dict. Pract. Med., vol. i. p. 613. ¶ Lond. Med. Gaz., vol. v. p. 397.

3186. In Deafness, a seton or issue at the nape of the neck or on the arm, is occasionally useful as a derivative; but they are inferior in efficacy to blisters behind the ears, and are not only useless, but even injurious in nervous deafness, or in that caused by excessive discharges, &c.

3187. In Chronic Inflammation, Congestion, and in some other Chronic Affections of the Liver, an issue or seton over the region of that organ is often productive of the greatest benefit. I have known the best effects follow their establishment, and cannot but consider that they are too much neglected in this class of diseases. Dr. Graves* bears testimony to their value in these cases.

3188. In Chronic Enlargements and Inflammations of the Joints, issues in the neighbourhood of, not upon, the joint are powerful and beneficial remedies. In Morbus Coxarius, Albers attributes great efficacy to them.

3189. In Bronchocele, which resists the use of Iodine, it has been proposed to pass a seton through the enlarged gland. Several successful cases are recorded. Dupuytren thought highly of the practice, although he justly observes, that a seton is not to be regarded as a certain cure for every bronchocele. Great caution is necessary clearly to distinguish the character of the tumour, previous to employing a seton, as it is evident that if it be of a malignant nature, the worst effects would result. Sloughing has in some instances followed its employment; and, in others, it has produced no sensible improvement.

3190. In Ununited Fractures, setons form the most successful treatment According to the tables of Mr. Norris. of 46 cases treated by seton, 36 were cured, 3 partially so, 5 derived no benefit, 2 died.

3191. Some obstinate Cutaneous Affections, Sycosis, Impetigo, Psoriasis, &c., which resist all other remedies, disappear rapidly on the establishment of a seton or issue. Dr. Graves § gives an excellent piece of advice on this subject. When the disease is of long standing, always insert an issue in the arm, before you attempt a cure. " I have seen," he adds, "water on the brain, and other fatal consequences, from the neglect of this precaution."