134 FISTULA AND POLL-EVIL 



one side than from the other. Sometimes in 

 misdirected plunges of the scalpel into the poll 

 the ligament may all be left on one side, some- 

 times two-thirds is on one side and one-third 

 on the other, etc. And again, if the incision 

 was not made straight there may be more liga- 

 ment anteriorly than posteriorly on a given 

 side. These are points to keep in mind at all 

 times. The point is to remove all of it along 

 the affected zone, but no more than is necessary 

 posteriorly. 



Packing and Suturing. Third Step. — The 

 w^ound is now wadded with a hemostatic pack 

 of oakum and sutured securely. We make no 

 attempt to wad the cavity so very tight posteri- 

 orly on account of the danger of spinal pres- 

 sure, although it must be well filled. The ob- 

 ject in making a safe hemostatic pack for poll- 

 evil is to distribute the pressure evenly over 

 the whole cavity. That is, severe pressure from 

 hard lumps of the oakum must be avoided, es- 

 pecially at the posterior end of the wound. 

 iWhen the patient is standing again the poll 

 and bloody neck are washed off with liberal 

 ablutions of water and then the poll is covered 

 w^ith a layer of oakum or cotton soaked in mer- 

 curic chlorid solution and this is held in place 

 Avith a hood made from muslin or common bur- 

 lap. 



