OPERATION AGAINST COLD ABSCESS OF THE SHOULDER 455 



In the face of the certain unfavorable course these char- 

 acteristic abscesses always run, prompt surgical intervention 

 should be recommended in every instance. The only oc- 

 casion for delay is the existence of peripheral oedema, which 

 always subsides after several days. 



The operation described below is universally successful 

 only if performed during the earlier stages of the disease, for 

 if the pyogenic process has ended and the permanent growth 

 has already become well rooted, total ablation is the only 

 help. 



TECHNIQUE. — In fairly tractable horses it is possible 

 to perform the operation in the standing position by aid of 

 the twitch and side-line or stocks. The recumbent position is, 

 however, always much more satisfactory, and is in fact, es- 

 sential when a restive horse is to be dealt with. 



The tumor is clipped, shaved and well washed with anti- 

 septic water, after which a vertical incision, generally about 

 four inches long, is made across its most prominent part. (If 

 any fistulous tracts exist an elliptical resection including the 

 orifices in the excised zone is substituted for-the straight in- 

 cision). The incision is then carried carefully forward 

 through the sclerotic wall into the abscess cavity, which, on 

 account of small dimensions, may sometimes be difficult to 

 find. When the contents have been evacuated the major 

 portion of the growth is excised from center toward the 

 periphery on both sides of the incision by slicing it piece by 

 piece with the right and the left sage knives, each for its 

 respective side. The slicing is continued outward in both 

 directions as far as the pure fibrous tissue extends, and is dis- 

 continued as soon as a predominance of muscular tissue ap- 

 pears in the foreground. 



Following this enucleation, the cavity is well seared with 

 hot irons until all bleeding is arrested. The searing should 

 be a thorough one, but some care must be exercised not to 

 needlessly burn the skin along the edges of the incision. 

 Bleeding from the large vessels, sometimes cut in abscesses 

 located near the jugular groove, should be arrested with for- 

 ceps. 



If any deep-seated bleeding that cannot be reached with 

 the hot iron exists, it is controlled by packing, and if neces- 

 sary by suturing the packing into the cavity. 



Very little after-care is required. Dusting with a pre- 

 servative powder (boric acid) to prevent putrefaction of the 

 eschar and astringent washes after it has sloughed out, is the 

 only treatment required. Cicatrization is rapid and the 

 normal physiognomy of the shoulder is soon restored, 



