80 FISTULA AND POLL-EVIL 
between the two halves of the funnicular per- 
tion of the ligamentum nuche into the loose 
tissue beneath and drawn backward again the 
full length of the wound. This opens the cen- 
tral cavity which in typical fixtule is uni- 
formly located at the level of the second tho- 
racic spine. 
The third step. Blood is now hurriedly wiped 
out, the forceps are drawn upon with force to 
reduce the flow and the large spurters are 
snapped up in hemostats. [t is not, however, 
advisable to devote much time to this hemo- 
stasia unless efforts at its control promise to be 
promptly effectual, since futile attempts ce- 
lay the work and add to the blood loss. If the 
operation antedates the formation of pus, that 
is, if the contents are still sero-fibrmous, there 
is no occasion for doing anything else than that 
of now inserting the drainage tube, while on 
the other hand, if there is pus and the igament 
is found more or less riddled with disease, re- 
section of the diseased parts is now under- 
taken. In very old cases it is entirely removed, 
in more recent cases its mesial parts are sliced 
off. In this step we also in many cases en- 
deavor to resect the wall of the sac, or as much 
of it as is accessible for hurried removal, leav- 
ing the ligament untouched. This, of course, 
is possible only where the sac is small and on 
