FISTULA OF THE WITHERS 15 



in every case to pick out this decidedly limited area. 

 The incision must then run horizontally and must be 

 at least two inches wide through skin and underlying 

 musculature. From this incision a stab-wound is then 

 made through the tumefied parts running obliquely 

 upwards towards the normal apex of the withers, not 

 stopping until the top is reached just under the mid- 

 dle line. (The two-inch incision is made with a sharp 

 scalpel through the skin and subcutaneous tissue. A 

 stab is then made with a long abcess knife from the 

 mouth of this incision, obliquely upwards and in- 

 wards, until it reaches the normal apex of the withers.) 

 This stab-wound is then widened laterally with a long, 

 straight probe-pointed bistoury. This drainage must 

 always be made on both sides, even if the condition 

 is apparently, confined to one side only. 



When these openings have been made as directed 

 the first treatment is given at once consisting of thor- 

 ough, irrigation with a ten per cen solution of 

 chromium trioxide. This is done most satisfactorily 

 with a fountain syringe, using a long nozzle, which 

 can be inserted in the wound far enough to reach 

 nearly to the top of the withers. - 



Chromium trioxide is the remedy of choice here. 

 It stops sloughing and odor almost immediately and 

 its action is painless. 



When the first treatment has been given, both 

 openings should be snugly packed their full length 

 with gauze, which is allowed to remain for eight or 

 ten hours. It is then removed and the wounds are 

 allowed to remain open. Subsequent treatment con- 



