TREATMENT 103 



been found to be good practice. We have de- 

 pended upon the completeness of the extkpa- 

 tion as the main treatment, and in order to 

 properly carry out this plan we have found 

 it necessary to place the patients in the re- 

 cumbent position with the neck well stretched 

 downward to expose the field to the best ad- 

 v^antage. Attempts to extirpate sitfasts of 

 this character in the standing position end in 

 failure to remove all of the dead elements. 

 With the head elevated, the skin folded, the 

 patient lunging about and the blood masking 

 the view, it is never possible to work accu- 

 rately, and a misdirected or incomplete extir- 

 pation is the result. 



By placing the patient on the operating table 

 or down on the ground with ropes, the neck 

 can be drawn downward, the parts cleaned, 

 the blood well baled and the whole mass of 

 dead and unviable tissues can be cut away. 

 Prompt healing will then follow. 



Once the fistula has formed it will be neces- 

 sary to operate promptly to prevent the spread 

 of the advancing inflammation into the lamel- 

 lar portion of the ligament. 



We cast the patient clean and shave the neck 

 and then make an incision no less than eiQ'ht 

 inches long in the median line through the 

 skin, pad of the mane and down between the 



