70 FISTULA AND POLL-EVIL 



cause severe pain, prolonged discomfort and 

 permanent blemish. Often large patches of 

 integument slough away ( Fig. 4 ) . 



The only beneficial effect of caustics is the 

 widening of the aperture and tract for drain- 

 age and since this can be accomplished better 

 and without discomfort by other means the one 

 argument in their favor loses force. 



The treatment of fistula of the withers which 

 in our hands has given the best results is 

 prompt, thorough, surgical intervention. Our 

 operation of choice and which is hereinafter de- 

 scribed consists of a median line incision ex- 

 tending from the crest of the withers forwards 

 six to twelve inches and downward through the 

 skin, the pad of the mane and then between the 

 two halves of the ligamentum nuchas into the 

 space beneath lying over the summits of the 

 second and third thoracic vertebrse. This is 

 followed by a resection of such parts of the 

 ligamentum nuchge as are thought to be harm- 

 ful and then by making lateral drainage 

 apertures from the bottom of the cavity to the 

 surface of the cervical region into which a 

 perforated drainage tube is inserted. 



Radical Operation for Fistula of the Withers 



Prepai^ation. — As the procedure is one of 

 some magnitude, attended with all of the dan- 



