40 FISTULA AND POLL-EVIL 



predilection of typical fistula of the withers is 

 stubbornly anterior to the summit of the 

 withers — in the space where tlie spines decline 

 abruptly into the cervical region. 



The sac forms slowly and without apparent 

 pain or discomfort to the patient. We have 

 found ample evidence post-mortem in subjects 

 that have died from other causes that cysts of 

 this character sojourn here without attracting 

 attention. They are too small to bulge ex- 

 ternally and cause no distress that would at- 

 tract one's attention to them. These hidden 

 cysts are sometimes the size of an egg and 

 sometimes as large as a base ball, and when 

 old are so well encapsulated as to prevent fur- 

 ther development. Thus cysts may never de- 

 velop into fistuhe or, in other words, the sac- 

 cular stage may never advance into the fis- 

 tulous stage. The process is arrested by 

 encapsulation and later the fluid content is re- 

 abs()r})ed, leaving no trace of its previous ex- 

 istence. The resulting cicatrical tissue is lost 

 in its connective environment. This process of 

 arrested develojnnent, encapsulation and reab- 

 sorpfion occurs also in clinical cases. Or in 

 other words, a clinical case of fistula of the 

 withers in tlie saccular stage tliat has never 

 been exposed to extraneous microorganisms 

 may disappear spontaneously. It is tlius that 



