RADICAL OPERATION FOR POLL-EVIL 331 



and the axis or in a subcutaneous abscess, the force of the 

 morbid process is always sooner or later centered upon this 

 yellow elastic structure, which, by undergoing a slow pro- 

 cess of destruction, acts as a foreign object, and provokes the 

 evolution of a succession of abscesses and fistulous tracts 

 and the formation of more or less connective tissues around 

 them. The process may.be acute, subacute or chronic from 

 the beginning, but in every case it finally terminates into a 

 chronic morbidity, encroaching more and more into the 

 depths of the poll until the periosteum of the atlas, the 

 atlas itself, the occipital bone, the occipito-atloid articulation, 

 the meninges and even the brain and spinal cord become 

 seriously implicated. Spontaneous cicatrization is excep- 

 tional; poll-evil, on the contrary, usually runs a slow but 

 certain course toward a fatal termination, unless prevented 

 by curative measures. The close proximity of the disease to 

 the highly sensitive nervous structures and to the cranio- 

 vertebral diarthrosis adds materially to the seriousness of 

 this fistulous condition as compared witji similar conditions 

 at other parts of the body. , 



The operation described below is indicated in almost all 

 poll-evils. The only exceptions are superficial abscesses and 

 processes implicating only the tendons of the cervical mus- 

 cles (superficial poll-evil), which conditions yield to simpler 

 interventions. 



It is important to resort to the operation early; before the 

 process has, by reason of its duration, encroached upon .the 

 subjacent structures, — the bones, synovials, meninges, brain, 

 etc. There is never any reason to postpone the operation 

 after the physiognomy of the region or the chronicity of the 

 process indicates that the ligament is involved. 



CONTRAINDICATIONS.— This radical operation is 

 useless and dangerous against poll-evil implicating the 

 bones, articulation, meninges, etc. Its usefulness is limited 

 to the uncomplicated form. Moreover, it must be avoided 

 in the weak, debilitated subject, whose vitality will totter 

 under the shock provoked by the operation, or whose state 

 of health clearly indicates nervous involvement. 



RESTRAINT. — The operation can only be successfully 

 performed in the recumbent position, under the influence 

 of general anaesthesia. Restraint without general anaes- 

 thesia is not sufficient, on account of the great pain, the co- 

 pious bleeding and the long duration of the procedure. The 

 operating table is almost indispensable to its successful exe- 

 cution, although by propping up the head after the anses- 



