458 PROGRESS OF VETERINARY SCIENCE AND ART. 
coat, and thus performing only partial extirpation. In the first 
place, along incision was made from the fistula, the whole length 
of the vein upwards, but the enormous wound resulting called 
for many sutures, and for a considerable time to heal. Rey 
modified it by making three incisions, the one at the spot of 
the fistula, the second at the bifurcation of the jugular, the 
other over the internal maxillary vein in the parotidean region. 
A long bistoury was then used to dissect round the vein and 
draw it out, but the operation is a long and difficult one, 
though the issue is very favorable, and cicatrization more 
rapid than in the former method ; sometimes a cicatrix was 
formed in from fifteen to twenty days. 
The anatomical study of the diseased veins, clearly referred 
to in the preceding pages, led M. Rey to adopt a second plan. 
The infiltration of the cellular coat with lymph, and the mo- 
dified condition of the middle tunic, render these readily se- 
parable ; this is an invariable occurrence. Toothed forceps, 
suture needles, with waxed thread and bistoury, are the instru- 
ments required. The three incisions, as above, are made. 
The internal maxillary is sometimes tied, but if obliterated is 
simply divided ; the external masseter is also tied and 
divided ; the occipital vein is only cut through, and never 
ligatured. Sometimes Rey performs a fourth incision just 
over the edge of the maxillary bone, to tie the external mas- 
seter at this point. The index finger is passed into each 
incision, and made to penetrate between the external and 
middle coat ; and the cylindrical object constituting the dis- 
eased vein is easily detached. The process of detachment is 
generally performed before the ligatures are put on. The 
last stage of the operation is the extraction of the isolated 
portion of vein, and it is dissected away with the knife even 
below the seat of the fistula, and then cut across. From six 
to eight inches of the vessel are removed. A suture each for the 
upper wounds, and two for the lower one, are required. The 
horse is kept on low diet and turned round in his stall, so that 
he may not rub his neck. Great pain about the neck and 
irritative fever are observable the day after the operation, 
but all subsides in a very few hours, and in from fifteen to 
twenty days the animal is perfectly cured. 
Professor Rey says that there are certain complications 
which may present themselves at the time of the operation : 
such as difficulty in getting at the vein, and accidental 
hemorrhage. M. Rey has never seen hemorrhage at the 
separation of the ligatures. There is no need of tying the 
vein below the seat of the fistula, as it is always obliterated 
in its course towards the heart. 
