TREATMENT 101 
first there is no swelling and the patient dis- 
plays little discomfort, but later when the dead 
tissues begin to putrefy and impregnate the 
adjacent tissues with infections or serve as an 
avenue of entrance into them, the subject be- 
comes unfit to work with a collar, a certain 
amount of discharge begins to appear around 
its borders, and the subjacent musculature be- 
comes swollen or bulges from the swollen lig- 
aments within. Soon the slough which is a large 
cone-shaped mass of skin and pad detaches 
itself and can then be removed by blunt dis- 
section, leaving a deep well whose bottom is 
the ligamentum nuche. Treated as an open 
wound the cavity often closes up with nothing 
more harmful than a slight deformity of the 
neck which will vary according to the size of 
the slough removed. 
Many cases, however, do not behave so well. 
Cicatrization of the cavity leaves a small fistu- 
lous tract that runs down to and often under 
the ligamentum nuche, and which in spite of 
local treatment continues to discharge consid- 
erable pus. The sides of the neck along the 
ligament bulge slightly in both the forward and 
the downward directions. This is fistula from 
sitfast. Later if no relief is given the lamellar 
portion becomes involved, at first only slightly 
but later over a wider and wider zone until the 
