III.— THORAX. 



FISTULOUS WITHERS. 



59. A ten-year-old Irish mare, sent for examination on the 30th 

 January, i8gg. 



For several years this mare had been exclusively used for saddle 

 work. Towards the end of December, 1898, a hsematoma developed 

 on the withers, was punctured on either side at its lowest point, the 

 cavity injected with antiseptic liquids, and the surface repeatedly 

 blistered. 



The wound on the right side closed in three weeks, but that on the 

 left suppurated and became sinuous. The pus, which had difficulty 

 in escaping, macerated the supra-spinous ligament, which became 

 necrotic. 



State on Examination. The right side of the withers was marked by 

 a cicatrix ; the left, especially towards its posterior part, exhibited a 

 diffuse, very tender swelling, pierced about an inch from the highest 

 point of the dorsal spinous processes by a sinuous wound into which a 

 probe penetrated for a distance of nearly four inches. Blood-stained 

 pus ran from the opening. 



The sinuous tract ran obliquely forwards and slightly upwards, 

 appearing to end over the portion of the supra-spinous ligament 

 covering the fifth dorsal vertebra. 



Treatment. — On the 30th January the sinus was laid open parallel 

 to the line of the superior spinous process for a distance of four inches, 

 exposing the necrotic portion of the ligament, which was excised with 

 the bistoury and curette. The wound was cleansed, the margins were 

 touched with tincture of iodine, the parts powdered with iodoform, the 

 edges brought together by three sutures, and covered with layers of 

 iodoform gauze fixed in position with collodion. 



The dressing was renewed every second day until the loth February', 

 at which time the back portion of the wound was granulating, though 

 a fresh necrotic point had developed in front. 



On the nth February the animal was cast and the anterior angle 

 of the wound laid open, when the cartilaginous disc covering the 

 superior spinous process and a part of the supra-spinous ligament were 

 seen to be necrotic. With the help of the bistoury and curette the 

 dead structures were removed. The wound was washed with one per 

 thousand sublimate solution and dressed with tannoform. 



During the following days suppuration was trifling, and hopes of 

 cure were entertained. After a period of real improvement a fresh 

 complication occurred : at the commencement of March the liga- 



