124 FISTULA AND POLL-EVIL 



the tide of the inflammatory process towards 

 resolution. On the other hand, if nervous com- 

 plications develop as a phase of later stages, 

 the case is always hopeless. The practitioner 

 is warned against operating upon such cases, 

 because the operation is always blamed for the 

 unfavorable termination, and in fact rightly 

 so, since the advancement of the process into 

 the cord and brain is accentuated rather than 

 retarded by surgical treatment at this stage of 

 the development. And besides, patients thus 

 stricken are unable to withstand the enfeebling 

 influence of such a major operation. 



Involvement of the Occipito-Atlantoid Ar- 

 ticulation. — Lying adjacent to the initial focus 

 of the disease, this joint very often becomes 

 infected within its capsular ligament at an 

 early stage. As a rule, however, this compli- 

 cation features later stages, the joint becoming 

 involved gradually through the medium of the 

 atlas. The periosteum and then the bone, 

 soaked with pus develop chronic inflammation 

 that advances into the joint through the articu- 

 lar cartilage. When this occurs it is only a 

 matter of weeks before serious results ensue 

 through involvement of the meninges. The 

 subject thus affected is in sore straits from the 

 severe pain it suffers, especially in moving the 

 head. 



