Issues are recommended as a general remedy, to act as a drain to the constitution, and to render the drying up of the ulcer safe. In this point of view, they appear to be altogether useless and unnecessary; but, when employed as part of the local treatment, they are much more useful. The benefit arising from the use of issues, in the cure of scrophulous inflammation of the bones and joints, is now so fully established, by the practice of every surgeon, that it is useless to insist upon it here. In these cases, it is necessary to insert the issue, which is generally made with caustic, as directly over the affected part as possible; and the size of this issue ought in general to be correspondent to the extent of the disease. There are two circumstances which greatly tend to render this practice efficacious, and which ought to be fully attended to: First, that the disease be allowed to gain as little ground as possible before the insertion of the issue, or that the issue be inserted as early after the disease is observed as the patient will permit. Second, that, during the continuance of the issue, every circumstance be avoided which may counteract its use, such as much use of the joint, or other species of irritation. In diseases of the lower extremities, therefore, whatever exercise produces pain must be carefully avoided; and, for the same reason, in diseases of the spine, proper contrivances to relieve the diseased bone from pressure are necessary to be conjoined with the issue. It sometimes happens, that matter has either formed before the insertion of the peas, or some time afterward. In this case, it either comes to be discharged by an opening through the ulcerated surface, or issue, or it bursts at a more dependent part. In the first situation, no change of treatment is necessary; in the second, it is of service to insert a pea over the mouth of the aperture, which has a tendency to heal the part below, and prevent the formation of a tedious sinus. When the part becomes free from pain, and the soft parts have subsided in their swelling, and matter does not appear to be forming, or does not continue to be formed, if it had already been secreted, we may consider that the effect of the issue is now produced, and may begin gradually to diminish its size.