316 VKTERlNARY SURGICAL OPERATIONS 



deep-seated lesions of the ligament and bone have safely- 

 cicatrized. 



AFTER-CARE. — The wound and the setons are washed 

 daily with strong antiseptics. The latter, after being Washed 

 clean, may be soaked in tincture of iodine before being drawn 

 into the tract, and the wound along the withers is packed 

 with boric acid, or boric acid ninety-five per cent and iodo- 

 form five per cent. The tape, at the end of eight to ten 

 days, should be replaced with new ones larger than the 

 first, to widen the tracts. At the end of twenty-five days 

 they are -removed. Cicatrization is generally complete in 

 thirty-five days. 



SEQUELS AND ACCIDENTS.— Such radical inter- 

 vention upon the withers is not without danger. The un- 

 toward happenings are (i) septicaemia, (2) malignant 

 oedema, (3) tetanus, (4) gangrene, (5-6) shock and haemor- 

 rhage and (7) recurrence of the fistulae, the first five of which 

 are generally due to improper respect for cleanliness. Some- 

 times, these microbian conditions are predisposed by sys- 

 temic enfeeblement of the patient, which is made still worse 

 by the exhausting effects of the operation, and the creation 

 of ischemic areas by cutting large vessels is also an etiblo'gic 

 factor that must not be overlooked. A weak subject sub- 

 mitted to a long, sanguinary operation, that was none too 

 clean and in which the wound was packed tight and sutured 

 for twenty-four hours to control bleeding, very frequently 

 falls prey to fatal infections of the withers. These sequelae 

 must be prevented by avoiding operations on enfeebled sub- 

 jects, by cleanliness of hands and instruments, by controlling 

 blood flow with forceps, ligatures or hot irons and, lastly, 

 by not packing and suturing' the wound tightly, if done at 

 all. 



Shock -and haemorrhage are seldom very serious in 

 themselves. The shock is never great arid the bleeding can 

 always be controlled when threatening. They are, how- 

 ever, formidable predisposing factors to the sequelae just- 

 enumerated, from which standpoint preventive measures 

 are essential. Partial general 'anaesthesia with chloral and 

 rapid work prevent shock as well as the unnecessary loss of 

 blood. In the recumbent position chloroformization may be 

 deemed advisable in patients none to vigorous. 



Recurrence of the Fistulae. — Fistulae recur after rad- 

 ical intervention from failure to remove all of the necrotic 

 .portion of the ligament. The extent of the necrotic process 

 may have been under-estimated, or the 'operation itself, by 



