124 FISTULA AND POLL-EVIL 
the tide of the inflammatory process towards 
resolution. On the other hand, if nervous com- 
plications develop as a phase of later stages, 
the case is always hopeless. The practitioner 
is warned against operating upon such cases, 
because the operation is always blamed for the 
unfavorable termination, and in fact rightly 
so, since the advancement of the process into 
the cord and brain is accentuated rather than 
retarded by surgical treatment at this stage of 
the development. And besides, patients thus 
stricken are unable to withstand the enfeebling 
influence of such a major operation. 
Involvement of the Occipito-Atlantoid Ar- 
ticulation.—Lying adjacent to the initial focus 
of the disease, this: joint very often becomes 
infected within its capsular ligament at an 
early stage. As a rule, however, this compli- 
cation features later stages, the joint becoming 
involved gradually through the medium of the 
atlas. The periosteum and then the bone, 
soaked with pus develop chronic inflammation 
that advances into the joint through the articu- 
lar cartilage. When this occurs it is only a 
matter of weeks before serious results ensue 
through involvement of the meninges. The 
subject thus affected is in sore straits from the 
severe pain it suffers, especially in moving the 
head. 
