Special Injuries of Bones, Joints and Muscles. 319 



traction can only be undertaken by one intimately ac- 

 quainted with the parts. 



POLL EVIL. 



This is of two kinds : 1st, A simple abscess, the result of a 

 blow or other local injury, and which is only serious because 

 of the strong enveloping fibrous membranes that imprison 

 the matter beneath them ; and 2d, disease of the joint 

 between the head and the first bone of the neck, or be- 

 tween the first two bones. The first, if unrelieved, will 

 usually give rise to the second, since the surface of the 

 bones becomes the seat of disease which gradually extends 

 to and involves the joint. The milder form may be dis- 

 tinguished by the superficial position of the swelling and 

 fluctuation, and by the comparative freedom and ease 

 with which the head is moved, whereas in the other the 

 head is carried very stiffly and cannot be moved on the 

 neck without extreme suffering. 



Treatment. When seen early with only a slight inflam- 

 matory swelHng behind the poll and no fluctuation, purge 

 and keep a cooling lotion (tincture of arnica 2 oz., iodide 

 of potassium 1 dr., vinegar 1 qt., camomile infusion 1 qt.,) 

 constantly applied to the part, the patient at rest, and the 

 head tied up to the rack. If matter has formed and fluctu- 

 ation is felt, however deep, it must be opened at once. 

 Select the part where flixctuation is most marked and 

 plunge a knife into the cavity. Then with a bent probe 

 find the lowest point of the sac and cut down upon this, 

 making a large opening from which the matter may flow 

 as it forms. A tape should be tied in the wound and the 

 sac syringed out daily with a stimulating wash (chloride 

 of zinc ^ dr., water 1 qt.,) until from the disappearance of 

 swelling and matter it becomes evident that the sac is ob- 

 literated, when the tape may be cut, pulled haK way out 

 and left hanging from the lower wound until the upper is 

 closed, when it may be completely withdrawn. When 

 new sacs of matter appear these must be promptly opened 



