RADICAL OPERATION FOR- FISTULA OF THE WITHERS 313 



sides should be boarded up to protect against kicks. Casting 

 harness has no redeeming feature for such operations. It 

 is always more satisfactory to construct stocks than to at- 

 tempt the operation with the absolutely unsatisfactory re- 

 straint provided by harness. The operating table, on the 

 contrary, is fairly satisfactory, as the surgeon has fair access 

 to both sides, on account of the elevated position of the 

 patient. 



INSTRUMENTS, ETC.— 



1. Scalpel" and scissors. 



2. Curved probe bistoury. 



3. Dissecting forceps, probes. 



4. Artery forceps, several. 



5. Tumor forceps, large. 



6. Needles and silk suture, seton needle. 



7. Wadding of cotton. 



8. Antiseptics. 



A large curette should be. available in event of finding 

 disease of the "spinous processes. 



TECHNIQUE. — First Step.— Disinfection. — As the 

 withers is often found in a bad state of filth, considerable 

 time should be set aside before the operation begins to clean 

 up the region. If possible the surface of the withers and 

 shoulders is washed and cleansed with patience the day pre- 

 ceding, as otherwise much time is always lost in bringing 

 the putrid region into fit state for operation. The enlarge- 

 ment and a liberal surface around it, including the mane 

 hairs some distance forward, is clipped and scrubbed with 

 soap and water and then rinsed with sublimate solution. 

 Shaving, although not absolutely necessary, is always indi- 

 cated. Fluctuant abscesses are lanced and irrigated and fis- 

 tulous tracts discharging copiously are syringed out. 



Second Step. — The Resection.— On the side most affect- 

 ed a longitudinal incision is made parallel to the median line 

 and about one inch outward and long enough to overlap the 

 enlargement anteriorly and posteriorly. In depth it is car- 

 ried just beyond the inferior limits of the supraspinous liga- 

 ment, which is then dissected out as far forward and as far 

 backward as the incision admits. The ligament is cut 

 through transversely, gripped with the tumor forceps, 

 and then carefully dissected back to the other end of the in- 

 cision, where the resection is completed by another trans- 

 verse cut. In the middle the resected part is generally found 

 riddled with disease, but gradually terminates into a healthy 

 condition toward the ends, and beneath the diseased part 



