DISEASES OF THE WITHEBS. 777 



and liquid form, were held in high repute, even in the form of 

 actual cauterization, as recommended by Laf osse. In later times, 

 however, the serious effects which followed their appUcation caused 

 them to be ignored. Preparations of lesser severity were then 

 recommended, among which were Villate's solution; those of the 

 sulphates of copper or of zinc, in various degrees of strength; 

 of tincture of iodine, of spirits of turpentine, of nitrate of silver, 

 and even of tartar emetic, and their use was followed by good 

 results. 



Cantharides ointment, applied externally over the swelling, 

 and by injections into the fistulous tract, after being diluted with 

 tincture of cantharides, is also recommended. 



"When the pus has filtrated inside of the shoulder, Bouley and 

 Nocard suggest the propriety of "attempting to lacerate with a me- 

 tallic rod the cellular tissue of the internal face of the shoulder, so 

 as to produce an abscess by congestion, whose opening, which must 

 be made wide, would allow the escape of the pus, and the possible 

 frequent cleansing of the enormous fistula thus formed. By this 

 process one might avoid the serious accidents likely to result from 

 the sejoum of the pus, and its fermentation from the contact of 

 the tissues." 



For cases like these Lafosse recommended the trephining of 

 the scapula — a very serious operation. It is said to have been 

 successful with him, but it must be a difficult matter to perform 

 it properly in such a manner that the trephine is appUed at a point 

 on the surface exactly corresponding to the bottom of the fis- 

 tula. 



When all means of so stimulating the action of the parts as 

 to effect the arrest of the necrosis, and the sloughing of the morti- 

 fied structure have failed, there is but one alternative left, and 

 that is the direct amputation of the apex of the spinous process, 

 and the excision of the diseased portion of the Hgament. But 

 this operation, indicated by Lafosse, is possible only when the 

 disease is limited to the apex of the most prominent spinous pro- 

 cesses. It is positively contra indicated in low and thick withers, 

 in which the wound left after the operation would be a hollow, 

 cup-shaped depression, from which the pus would naturally gravi- 

 tate and filtrate in all directions. 



The instruments necessary for this operation are : A grooved 

 director, curved and straight bistouries, sage-knives, sharp draw- 



