FISTULOUS WITHERS. 497 



dividing the ligament an inch or two in front of the necrotic portion 

 (desmotomie cervicale). A mass of new tissue forms at this point, 

 constituting a barrier to the further forward spread of necrosis. 

 Once this is produced the sinus is freely laid open, and all the necrotic 

 portions of the ligament behind the cicatricial tissue removed. 



r The greatest difficulty is experienced where necrosis has attacked 

 the superior spinous processes of the vertebrae. Separation takes 

 a long time, and during this process new pockets may form and 

 fresh structures become necrotic. Should the diseased parts be 

 removed with the curette or saw, further necrosis usually occurs 

 on the surface of the bones, so that with this operation no progress 

 is made. Removal of the diseased spinous processes is only successful 

 where permanent irrigation can be provided and perfect asepsis 

 attained ; but, in such cases, the results are often highly satisfactory. 

 Unfortunately the inflammation and pus formation only occasionally 

 allow of this. Good recoveries can only be expected where pus 

 formation has almost entirely disappeared, and where no marked 

 swelling exists. 



Cadiot and Dollar describe a case of fistulous withers complicated 

 with necrosis of the supra-spinous ligament, and at a later stage with 

 necrosis of the ligamentous tissue covering the sides of the superior spinous 

 process of the third dorsal vertebra. The necrotic parts were removed 

 with the bistoury and curette, and the wound dressed with creolin, and at 

 later stages with iodine tincture and iodoform. Progress was very slow, 

 and supplementary operations became necessary. Spraying with warm 

 creolin solution, followed by dressing with traumatol, finally proved 

 successful, but the case lasted between four and five months. (" Clinical 

 Veterinary Medicine and Surgery.") 



Still graver is pus formation under the shoulder blade. In such 

 cases necrosis of the scapula and its cartilage readily occurs and 

 great difficulty is found in effecting the escape of pus. Suppuration 

 may extend to the inner surface of the scapula and the fascia of the 

 serrati muscles, and the disease thus become further removed from 

 the possibility of direct treatment. In such cases counter openings 

 at the posterior border of the scapula, trephining the scapula, and 

 the insertion of drainage-tubes, may be tried, though such treatment 

 often fails. Portal removed the entire cartilage of prolongation 

 of the scapula through a V-shaped incision, the point of the V being 

 above. A portion of the upper margin of the scapula was also 

 removed. Several divided arteries were ligatured. The wound was 

 dressed for three weeks with Villat's solution, and for a fortnight 

 with Rabel's solution ; cicatrisation was then complete. Such 

 success is, however, exceptional. 



