TREATMENT 103 
been found to be good practice. We have de- 
pended upon the completeness of the extirpa- 
tion as the main treatment, and in order to 
properly carry out this plan we have found 
it necessary to place the patients in the re- 
cumbent position with the neck well stretched 
downward to expose the field to the best ad- 
vantage. Attempts to extirpate sitfasts of 
this character in the standing position end in 
failure to remove all of the dead elements. 
With the head elevated, the skin folded, the 
patient lunging about and the blood masking 
the view, it is never possible to work accu- 
rately, and a misdirected or incomplete extir- 
pation is the result. 
By placing the patient on the operating table 
or down on the ground with ropes, the neck 
can be drawn downward, the parts cleaned, 
the blood well baled and the whole mass of 
dead and unviable tissues can be cut away. 
Prompt healing will then follow. 
Once the fistula has formed it will be neces- 
sary to operate promptly to prevent the spread 
of the advancing inflammation into the lamel- 
lar portion of the ligament. 
We cast the patient clean and shave the neck 
and then make an incision no less than eight 
inches long in the median line through the 
skin, pad of the mane and down between the 
