FISTULA 517 



the mass of muscles surrounding the shoulder joint, and consequently be- 

 yond the reach of the most accomplished finger. 



Treatment. — If a correct diagnosis could be made it is extremely doubtful 

 if any treatment would be successful, such cases generally are not seen 

 except at post-mortem examinations of subjects that have long been valueless. 

 It has only a pathological interest to the veterinary student, and may be 

 dismissed as beyond the scope of this work. 



FISTULA 



Fistulous wounds are met with in other parts besides the withers, but 

 to the horseman fistula means an open wound following upon a swelling in 

 or near the shoulder-blades or that part of the animal designated the 

 withers. It is at all times a troublesome disease, and not rarely incurable 

 for reasons that will presently be seen. 



Causes. — These are blows and contusions, not necessarily violent but 

 repeated, as when an ill-fitting collar jolts upon the withers in going down- 

 hill, or a saddle too narrow or in want of stufling pinches the tissues 

 beneath. In the gentleman's stable fistula is now of rare occurrence, and 

 was becoming less common in agricultural districts until the general 

 adoption of mowing-machines, which have proved very fruitful of wrung 

 and fistulous withers. The first indication may be " collar pride," or the 

 patient slave may endure the pain of a forming abscess until an enlargement 

 is observed by the attendant. The swelling, at first hard and extremely 

 painful, becomes softer as matter forms beneath and gradually comes to a 

 point, when it breaks, discharges a quantity of thick pus as in the case of 

 an ordinary abscess, but instead of healing up, there is subsidence of the 

 swelling and the establishment of a drain from which a thin but variable 

 discharge is poured out, a puckered opening in the skin shows a distinct 

 tube inside from which the matter flows, and if this is traced to its source 

 branches may have been established which run under the blade-bone 

 (scapula), and ramify among the loose connective tissue, where, in the 

 living subject, it is impossible to reach except by the forcible injection of 

 fluid agents. These constitute the incurable division, but there is often 

 very little pain and perhaps no lameness in an old-established case, and 

 such horses are worked for years in country districts where visits are 

 not expected from oflicers of the Royal Society for the Prevention of 

 Cruelty to Animals. No doubt many horses with this disease can work in 

 a breast-collar without pain or inconvenience, but it can hardly be supposed 

 that an ordinary collar can be so fitted as to avoid pressure upon the parts 

 afiected. 



Treatment. — Early recognition of the injury and fomentation with hot 

 water may bring the abscess to a head so quickly as to avoid the bur- 

 rowing which causes the establishment of the drain. "When the soft place 

 or " point " of the abscess yields very readily to the pressure of the finger, it 

 may be assumed to be ready for the lancet, which should be boldly plunged 

 into it, and the matter evacuated by gentle pressure of a sponge dipped in 

 moderately hot water. A pledget of tow dipped in turjoentine and pushed 

 into the cavity will ensure its pretty complete evacuation the next day, and 



