TREATMENT 101 



first there is no swelling and the patient dis- 

 plays little discomfort, but later when the dead 

 tissues begin to putrefy and impregnate the 

 adjacent tissues with infections or serve as an 

 avenue of entrance into them, the subject be- 

 comes unfit to work with a collar, a certain 

 amount of discharge begins to appear around 

 its borders, and the subjacent musculature be- 

 comes swollen or bulges from the swollen lig- 

 aments within. Soon the slough which is a large 

 cone-shaped mass of skin and pad detaches 

 itself and can then be removed by blunt dis- 

 section, leaving a deep well whose bottom is 

 the ligamentum nuchge. Treated as an open 

 wound the cavity often closes up with nothing 

 more harmful than a slight deformity of the 

 neck which will vary according to the size of 

 the slough removed. 



Many cases, however, do not behave so well. 

 Cicatrization of the cavity leaves a small fistu- 

 lous tract that runs down to and often under 

 the ligamentum nuch^e, and w^hich in spite of 

 local treatment continues to discharge consid- 

 erable ])us. The sides of the neck along the 

 ligament bulge slightly in both the forward and 

 the downward directions. This Ls fistula from 

 sitfast. Later if no relief is given the lamellar 

 portion becomes involved, at first only slightly 

 but later over a wider and wider zone until the 



