94 FISTULA AND POLL-EVIL 
spite of care the loss of blood assumes danger- 
ous proportions. And while fatalities 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 our 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 prompt cicatrization. 
When this is not found to be the cause a new 
operation the 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 measures 
which will be considered under the head of “‘se- 
