38 POIylv nvil, OPERATION 



lyN, into the diseased area beneath the latter. Dissect the 

 ligamentum nuchse away from the adjoining tissues as far 

 back as diseased, divide it obliquely upward and backward 

 as indicated at AA, and detach anteriorly from the base of 

 the occiput. Be careful to remove every portion of the 

 ligament in the area indicated and all calcareous deposits or 

 other diseased tissues. 



With lyuer's forceps, groove a channel about 2 cm. wide 

 from behind to before directly upon the median line, through 

 the occipital protuberance to the depth of about 2 cm. mak- 

 ing the bottom as near as possible on a level with the wound 

 in the soft tissues as indicated by the dotted line, AA. 

 Using lyUer's forceps as a curette, detach all vestiges of the 

 neck ligament from the base of the occiput and leave the 

 bone bare and smooth.' If the I/Uer or rongeur forceps are 

 not available the grooving of the occiput may be accom- 

 plished with a strong curved bone gouge. Or the grooving 

 of the occiput and curetting away of the attachments of the 

 neck ligament to the base of the occiput ma5' be very 

 effectually accomplished with a hoof knife. Be careful to 

 avoid penetrating the cranial cavity or the occipito-atloid 

 articulation. If the operator is not perfectly clear regarding 

 the anatomy of the parts, he would do well to have before 

 him a sagittal section of the head of a horse which may 

 serve as a guide. In curetting the ligamentous attachments 

 from the occiput, the operator should keep the index finger 

 of the left hand at the bottom of the wound, against the 

 occipito-atloid ligament in order to protect it from injury. 

 The operation is rendered more safe also by rigid control of 

 the hemorrhage to which end he needs an ample number of 

 compression artery forceps. 



Control the hemorrhage, cleanse and disinfect the wound, 

 pack with antiseptic gauze and suture except at the anterior 

 part, where the tampon should slightly protrude. Disin- 

 fect the margins of the wound. Remove the tampon after 



