The surgeon should be on the watch during the healing process to avoid any burrowing or the formation of fresh sinuses. Should the discharge from the surface of the wound suddenly become excessive, it is evidence that a sinus has formed, and a careful search should be made for it. Sometimes it begins under the edges of the wound, at other times at the upper or lower ends of the cut surface, and occasionally it seems to branch off from the base of the main fistula. Pain in or near the seat of the healing fistula is another symptom of burrowing, and when complained of the surgeon should carefully investigate its cause. After an operation for fistula, the patient's bowels should be confined for three or four days, for which purpose opium is usually given. At the end of this time the bowels may be opened by the administration of a dose of castor-oil, and so soon as the patient feels a desire to go to stool an enema of warm water should be injected, which will tend to render the feces soft and fluid and hence make their passage easier. The patient should be kept in a recumbent posture until the fistula is healed; and until the bowels are moved the diet should be liquid—such as milk, beef-tea, and broths. The time required for a patient to recover after an operation for fistula in ano varies with the extent of the disease. In an average case it will be necessary to keep the patient in bed for two or three weeks, and confined to the house for a couple of weeks longer. [Illustration: Fig. 44—Set of three Cautery Irons to fit one handle.] [Illustration: Fig. 45—Paquelin's Thermo-Cautery.] INCONTINENCE OF FECES is an unpleasant sequela to the operation for fistula. It is, happily, of rare occurrence, and follows only extensive operations, such as those in which the sphincter has been divided more than once, etc. When it exists to any extent it is productive of great annoyance to the patient, possibly more so than the original fistula. The application of the old-fashioned cautery-iron (Fig. 44), heated to the proper degree, or the small point of Paquelin's thermo-cautery (Fig. 45), applied to the cicatrix of the operation wound, will often suffice to relieve this trouble, by causing contraction of the anal outlet and giving tone and increased power to the sphincter muscle. Mr. H. W. Allingham, Jr.,[48] recommends for this condition freeing the ends of the muscle by a deep incision through the old cicatrix and allowing the wound once more to heal from the bottom by granulation. Dr. Chas. B. Kelsey[49] advocates in these cases the complete excision of such a cicatrix, exposing freely the divided ends of the sphincter and bringing them together by deep sutures, exactly as in cases of lacerated perineum.