THE SEAT OF POLL-EVIL 113 



addition, this is the usual seat of the sinus. The ligament becomes 

 more apparent if the occipito-atlantal joint be well flexed by pressing 

 the muzzle towards the chest. 



An incision is made longitudinally along the lateral border of the 

 ligament, and through this incision a grooved director is introduced, 

 which is insinuated beneath the ligament. Along the groove of tht 

 director a long, flat bistoury should be passed, with its cutting edge 

 directed towards the ligament. The ligament is thus cut through 

 during the introduction of the bistoury. It is advisable to separate 

 the edges of the wound to such an extent that the severed ends of 

 the ligament are plainly visible. These should then be examined and 

 any diseased portion excised. 



The cutaneous opening may be utilised for the removal of frac- 

 tured spicules of bone, and if the condition has advanced to a 

 considerable degree, so that a great quantity of inflammatory fibrous ^ 

 tissue has been formed, it will frequently become necessary to reflect ci 

 two flaps of skin in order that the inflammatory tissue may be sliced r^ 



>, 



away. This leaves a capacious gaping wound, which should be *"• 

 plugged with tow saturated with some antiseptic, such as a 10 per 

 cent, solution of zinc chloride. A drainage-tube is inserted at the 

 lower extremity of the wound, and the flaps replaced by inserting 



a loose suture, in order that they may hold the tow in position. c. 

 After two or three days the suture is cut and the flaps again reflected. "^ 

 The plug is removed and the wound examined. If it should present a 

 healthy appearance the flaps should not again be sutured, but the wound 

 treated in the usual manner by encouraging healing from the bottom. 

 Should the wound not present a favourable appearance upon the 

 removal of the plug, it should be thoroughly probed and examined for 

 fractured pieces of bone, diseased ligament, etc., and these should be 

 removed, or it may be necessary to slice away more inflammatory 

 fibrous tissue. The same process of plugging should be repeated, the 

 flaps of skin being again utilised to keep the plug in position. 



