94 FISTULA AND POLL-EVIL 



spite of care the loss of blood assumes danger- 

 ous proportions. And while fatahties from 

 this cause are not usual, the weakened state 

 produced by excessive bleeding operates with 

 other influences against the general welfare of 

 the patient during the first few days of con- 

 valescence. 



Recurrence 



When the withers tumefy again after the 

 wound has been healed for some time or when 

 it does not heal in the usual time, it is evident 

 that some necrotic ligament or bone still re- 

 mains. These may have been overlooked in the 

 operation or else the disease may have ad- 

 vanced into adjacent places. We have found 

 that most of oiu* recurrences are due to healing 

 of the wound before the spines have cast off the 

 sequestra. A second operation of lesser mag- 

 nitude often reveals a loosened segment which 

 on removal is followed by j^rompt cicatrization. 

 When this is not found to be the cause a new 

 operation tlie same as the first may be required. 



Complications 



The complications arising from fistula of the 

 withers independent of those caused entirely 

 by operations and other remedial measured 

 M'hicli will be considered under the head of "se- 



