50 FISTULA AND POLL-EVIL 



eously. Often the death follows an operation 

 postponed too long, postponed until the patient 

 is too weak to stand the ordeal of the extensive 

 intervention needed to cope with the neglected 

 condition. 



The location of the secondary pus cavities is 

 varied. Backward between the scapular car- 

 tilage and the dorsal spines as far back as the 

 caudal angle of the scapula and under the 

 rhomboideus, is a favorite location. Another 

 place where pus commonly gathers is in the 

 space under the scapula just above the insertion 

 of the serratus thoracalis, and sometimes this 

 same cavity is diverted also under this muscle 

 and then extends downward over the costal sur- 

 face as far down as the sternum. The most 

 serious secondary cavity, however, is the one 

 that seats itself in the cervical region on the 

 bodies of the vertebrae on one or both sides of 

 the lamellar portion of the ligamentum nucha^, 

 This one constitutes what has been called cervi- 

 cal fistula, a condition due to implication of the 

 ligament anteriorly. When a large area of the 

 lamellar portion is involved the neck tumefies 

 on both sides and one or more tracts form to 

 the surface, often as far forward as the middle 

 third of the cervical region. This is one of the 

 most hopeless terminations of fistula of the 

 witliers as the affected center is inaccessible to 



