TREATMENT 137 



is large. This sequel is manifested in two 

 ways. In some cases the wound heals every- 

 where except at the posterior end, where a 

 small fistulous tract remains. Probed it is 

 found to be deep. If forceps are introduced 

 the slough can usually be taken hold of and 

 drawn out. Sometimes the aperture must first 

 be enlarged. 



The other manifestation is the appearance 

 of a new phlegmonous condition on each side 

 of the neck just behind and below the posterior 

 end of the wound. The abcess is sometimes 

 threatening and unless properly handled may 

 end in a new fistulous condition quite difficult 

 to handle. The first sign of such a complica- 

 tion, w^hich usually occurs at about thirty-five 

 to forty days after the operation, must be met 

 by making an incision at the posterior end of 

 the old wound downward into the abcess cav- 

 ity, where a slough of the stump of the liga- 

 ment is always awaiting removal. 



It is our practice to make a careful examina- 

 tion of the wound at the end of thirty days 

 with a view of determining whether or not such 

 a slough exists, and to remove it if found. 



Recurrences and Failures 



The failures from the radical operation for 

 poll-evil are almost always due to procrastina- 



