CHAPTER V. 



fistulje. 

 Radical Operation for Fistula of the Withers 



DEFINITION. — Resection of necrotic parts of the su- 

 praspinous ligament, sometimes including portions of the 

 underlying spinous apophyses together with the construc- 

 tion of dependent drainage of the fistulous tracts and puru- 

 lent sinuses associated therewith. 



INDICATIONS. — Excepting acute superficial ab- 

 cesses of the withers suppurating processes that are com- 

 monly designated as "fistulas of the withers," consist of a 

 necrosis of the supra-spinous ligament with or without im- 

 plication of the subjacent bones, and in every case this 

 causative "necrotic center" must first be disposed of before 

 a diseased process will progress toward recovery; but on ac- 

 count of the position and direction of the tracts and sinuses, 

 resection of the necrotic structures alone is not sufficient. 

 Drainage must also be provided for them. Classical sur- 

 gical intervention, therefore, has two objects: (i) the total 

 resection of all the necrotic elements and (2) drainage of the 

 purulent tracts and sinuses. These two objects are named 

 in the order of their importance. To operate upon fistulae 

 of the withers with the object of simply providing drainage 

 at dependent parts is not sufficient intervention; the causa- 

 tive element must, in addition, be removed. Although the 

 evacuation of the confined pus through incisions made here 

 and there at more or less dependent parts may tend to ar- 

 rest the onward march of the disease, and the incisions may 

 be useful as drainage orifices besides serving as channels 

 through which to apply medical treatment, the highest 

 ideals in modern surgery are never thus attained. The 

 suppurative process goes on and on, week after week, and 

 although it may sometimes finally subside, it also very fre- 

 quently continues until chronic septicaemia or a disgusted 

 owner ends the loathsome scene, and all this because within 

 the depths of the tracts a necrotic ligament, acting as a for- 

 eign body awaits removal. 



However, no matter how essential is the resection of the 



311 



