50 FISTULA AND POLL-EVIL 
eously. Often the death follows an operation 
postponed too long, postponed until the patient 
is too weak to stand the ordeal of the extensive 
intervention needed to cope with the neglected 
condition. 
The location of the secondary pus cavities is 
varied. Backward between the scapular car- 
tilage and the dorsal spines as far back as the 
caudal angle of the scapula and under the 
rhomboideus, is a favorite location. Another 
place where pus commonly gathers is in the 
space under the scapula just above the insertion 
of the serratus thoracalis, and sometimes this 
same cavity is diverted also under this muscle 
and then extends downward over the costal sur- 
face as far down as the sternum. The most 
serious secondary cavity, however, is the one 
that seats itself in the cervical region on the 
bodies of the vertebrae on one or both sides of 
the lamellar portion of the ligamentum nuche. 
This one constitutes what has been called cervi- 
cal fistula, a condition due to implication of the 
ligament anteriorly. When a large area of the 
lamellar portion is involved the neck tumefies 
on both sides and one or more tracts form to 
the surface, often as far forward as the middle 
third of the cervical region. This is one of the 
most hopeless terminations of fistula of the 
withers as the affected center is inaccessible to 
