312 VETERINARY SURGICAL OPERATIONS 



necrotic portion of the ligament and bones, the operation 

 must not always be hurriedly resorted to. In the earlv 

 stages, while the tumefaction of the withers is large and the 

 exposure of the depths would necessitate making enormous 

 incisions to effect a perfect resection, and while the ex- 

 tent of the necrosis is yet difficult to determine, radical in- 

 tervention should be postponed. Incisions at dependent 

 points to evacuate the pus, to establish a drainage, and to 

 admit of a preparatory irrigation must be first made and then 

 after two or three weeks, when the acute inflammatory 

 stage has thus been cut short and the onward encroachment 

 arrested, resection of the ligament may then be practiced 

 with much greater facility and with much better results. 



The chronic fistula of the withers, already riddled with 

 fistulous tracts, or any specimen that is already discharging 

 from one or more orifices, should, on the contrary, be im- 

 mediately submitted to the radical operation. 



In extremely old cases, where pus in considerable quan- 

 tities has been discharging for months, and where the tracts 

 have burrowed deeply behind the scapula, the patient may 

 not possess sufficient vitality to withstand the haemorrhage 

 and shock of the operation, for it is indeed common for such 

 fistulas of the withers to reflect over the whole organism in 

 the form of a veritable chronic septicaemia that manifests it- 

 self by emaciation and other general symptoms. The fu- 

 tility of operating upon such subjects needs little comment. 



The author divides fistulse into three classes for opera- 

 tive treatment. These are: (i) those located posteriorly, 



(2) those located on the highest point of the withers, and 



(3) those located anteriorly. These are named in the order 

 of their seriousness, the latter being the most formidable of 

 all fistulse affecting the equine species. The first is generally 

 superficial and is otherwise more accessible for operation; 

 the second varies in seriousness according to the depth of 

 the tracts; while the third, located over the first and second 

 dorsal spines under the ligament nuchas, between the two 

 lateral groups of cervical muscles, and just above the en- 

 trance of the thorax, is a veritable puzzle to the surgeon on 

 account of the inaccessible location, often difficult to master. 



RESTRAINT. — The stocks are by far the best apparatus 

 to secure horses for operations upon the withers. These 

 may be supplemented by the administration of ten drams of 

 chloral hydrate in a drench one hour before operating. The 

 stocks should be provided with slings to prevent lying down 

 and with a back strap to restrict upward movements. The 



