FISTULOUS WOUNDS 431 



giving rise to death (necrosis) of the bones, or to their permanent enlarge- 

 ment and union with each other (anchylosis), producing a chronic stiff 

 neck; or the ulceration may extend even to the spinal canal, causing 

 pressure on the cord and consequent paralysis, or epileptic seizures, or 

 sudden death. One or both sides of the neck may be affected. 



The Treatment. In the early stages, when the swelling is hot and 

 tender, the treatment should consist of cold applications to the part, such 

 as cold douches, which may be applied by fixing a hose-pipe to a tap, or by 

 syringing two or three buckets of cold water over the poll three or four 

 times daily with a garden syringe. Then apply linen cloths soaked in a 

 solution of sal ammoniac and saltpetre in water. During this time the 

 animal should be kept on bran mashes or other light food, and receive a 

 dose of physic, to be followed by green foods in summer or roots in winter. 

 Should this line of treatment not be successful in allaying the inflammation 

 and reducing the swelling, we may be sure that it means to gather, particu- 

 larly if it becomes more painful to the touch. As soon as we are satisfied 

 that it is gathering (forming an abscess), we should encourage the process 

 as much as possible, for the sooner we can get the matter to the surface the 

 better. This is best effected by the application of hot-water fomentations 

 and stimulating lotions. If the swelling does not seem inclined to " point " 

 quickly, a smart blister to the most prominent part of it will usually hasten 

 on the process. Directly the abscess "points" we should lose no time in 

 opening it, and this should be done at the lowest part of the cavity, so that 

 a natural drainage may be obtained and retention of the matter avoided. 

 If this can only be properly done at this stage, we shall find very little 

 difficulty in healing the breach, i.e. when the great ligament of the neck 

 and the bones are not affected. 



If, however, as is usually the case, the wound is neglected at this stage, 

 the matter (pus) begins to burrow between the muscles, forming pipes 

 (sinuses) in various directions ; these must be bottomed and laid freely open. 

 There are various means of doing this. Some prefer the knife, but this, 

 even in skilful hands, is not always successful, because the pipes run in such 

 intricate and awkward directions that it is extremely difficult to follow 

 them; others, again, use caustics, and destroy the pipes and the surrounding 

 structures. There are several of these agents; one of the oldest, best, and 

 perhaps the commonest, is corrosive sublimate. Arsenic is often used, but 

 it requires great care ; and even with the most discreet it will sometimes act 

 far beyond their expectations, and damage or destroy neighbouring struc- 

 tures, which adds to the trouble of the case by causing delay, and may also 

 prevent recovery. If the cautery has been successful, all that is required 

 after is cleanliness and the application of some astringent and antiseptic 



