In anatomy, is the membranous part found in new born infants at the meeting of the coronal and sagittal sutures, and which at last ossifies. It is called fons pullans.
Fontanella, (a diminitive of fons, also fonticu-lus). A little fountain. In surgery, it is metaphorically used to signify the small aperture called an issue. Issues were made in Hippocrates' time, and have maintained their credit down to the present day. The parts where issues are generally made,are, 1st, on the coronal suture, just where it joins the sagittal; but a perpetual blister on this part is to be preferred: 2tlly, the neck: 3dly, the arms, near the lowest part of the deltoid muscle, in the interstice between it and the biceps muscle.: 4thly, above the knee, on the inside of the thigh, in a hollow, which may easily be perceived by the finger: 5thly, below the knee, on the inside of the leg, where there is a space between the muscles, filled with cellular substance: 6thly, on the back; but the fifth would be more useful and less troublesome, if placed above the knee.
The method of making an issue is, first to mark the part with ink; then the operator and an assistant having raised the skin with their fore-fingers and thumbs, the operator pushes a lancet through the skin, to make an opening spacious enough to receive a pea, or a larger substance if necessary. This is introduced and secured by a sticking plaster and bandage: it must be renewed every twenty-four hours.
A caustic is sometimes applied, and continued six or eight hours; the eschar cut, and a pea inserted. The caustic, in some instances, is allowed to slough off, and the discharge continued by means of a pea.
Instead of common peas, wooden or silver balls are sometimes employed to promote the discharge; at others the dried oranges, called orange peas, or pieces of gentian or orris roots cut to a proper size.
Issues resemble, in some part of their effects, blisters, and, like them, produce benefits very disproportioned to their discharge. They act, however, slowly, and are more applicable to chronic than acute diseases. They produce a less considerable, and often a less effectual, discharge than setons; but are more cleanly and less painful. When any acrimony occurs in the fluids, for, on some occasions, such must be allowed, the drain of an issue is highly useful; and it appears strikingly so from inflaming and discharging at those times when this acrimony is usually deposited on the surface. When considerable determinations of blood to the head occasionally take place, two large issues will often prevent the attack; and in this case, too, they discharge more violently at the expected period of suffering. In chronic inflammations of the bones, issues are of considerable importance. In those enlargements of the bones, which are observed in scrofula, they are of service; and in those of the vertebrae, which produce distortion, they are valuable remedies. (See Distorsio.) In gout, they seem often to prevent the too frequent returns of paroxysms, and we are led to employ them from a similar effect of those drains which arise from chalk stones. In nervous affections they are highly salutary, particularly in some cases of epilepsy; and in angina pectoris, Dr. Macbride thinks that they have been of service when put in the thigh. They were formerly often used to prevent complaints, particularly in children; but they are now found to be troublesome and unnecessary.
Issues are formed with great advantage when we would heal ulcers of long standing. In many cases, after the ulcers are healed, the issues may be gradually diminished, as the constitution improves; but even then, to dry up the issue hastily would not be judicious, as many disagreeable, and sometimes fatal, effects have been the consequence. See Bell on Ulcers, ed. 4. p. 140; his Surgery, vol. 4. p. 376, 384. White's Surgery. Lera on the Theory of Issues; and Hoffman, vol. vi.