80 FISTULA AND POLL-EVIL 



between the two halves of the funniciilar por- 

 tion of the hgamentum nuchge into the loose 

 tissue beneath and drawn backward again the 

 full length of the wound. This opens the cen- 

 tral cavity which in typical fixtula^ is uni- 

 formly located at the level of the second tho- 

 racic spine. 



The third step. Blood is now hurriedly wiped 

 out, the forceps are drawn upon with force to 

 reduce the flow and the large spurters are 

 snapped up in hemostats. It is not, however, 

 advisable to devote much time to this hemo- 

 stasia unless efforts at its control promise to be 

 promptly effectual, since futile attemj)ts de- 

 lay the work and add to the blood loss. If the 

 operation antedates the formation of pus, that 

 is, if the contents are still sero-fibrinous, there 

 is no occasion for doing anything else than that 

 of now inserting the drainage tube, while on 

 the other hand, if there is pus and the ligament 

 is found more or less riddled with disease, re- 

 section of the diseased parts is now under- 

 taken. In very old cases it is entirely removed, 

 in more recent cases its mesial parts are sliced 

 off. In this step we also in many cases en- 

 deavor to resect the wall of the sac, or as mucli 

 of it as is accessible for hurried removal, leav- 

 ing the ligament imtouched. This, of course, 

 is possible only where the sac is small and on 



