82 FISTULA AND POLL-EVIL 



pus. Necrotic ends sooner or later, without in- 

 terference, separate from the viable bone, and 

 then leave it carpeted with granulations which 

 now cicatrize with the rest of the wound. We 

 are, therefore, unequivocally opposed to the 

 removal of bone tissue other than the already 

 welMoosened sequestra, which are sometimes 

 Found floating in the cavity or feebly attached 

 in situ. 



The fourth step is the insertion of the drain- 

 age tube. This is done with the drainage tube 

 inserter. (Fig. 3.) 



Armed with the tube the point of the inserter 

 is placed at the bottom of the cavity and then 

 pushed out laterally in the downward direction 

 through the splenius and serratus cervicis mus- 

 cles to the surface. The skin must be incised 

 as the j)oint of the inserter bulges it out as its 

 point is not sharp enough to penetrate it un- 

 assisted by an incision. When inserted on the 

 one side the inserter is passed into the other 

 end of the tube and pushed through the same 

 place on the opposite side. This places the 

 tube across the bottom of the cavity and out to 

 each side of the neck. (Fig. 4.) 



When the operation is prolonged for any 

 cause and the blood loss has been great, we 

 postpone the insertion of the tube until the 



