46 FISTULA AND POLL-EVIL 



seat of the trouble as in the traumatic forms. 

 This hkelihood of fistulas to point at or near 

 one side of the summit has misled many a prac- 

 titioner away from the actual seat of the causa- 

 tive center. In short, the existence of the aper- 

 ture in a posterior location is no indication 

 that the case is not a typical one centered at 

 the usual place, under the ligament at the level 

 of the second dorsal spine. The aperture may 

 come at different very remote points that are 

 often deceptive. 



The average case is more acute. Given one 

 with a sac containing a quart of fluid with a thin 

 capsule and infected with virulent microbes 

 that produce an acute inflammatory process, a 

 channel is soon dissolved directly to the surface. 

 Often pointing occurs long before there is much 

 damage done to either the ligament and bones 

 and if proper treatment were instituted, these 

 might never become seriously involved. A cure 

 could be effected without disturbing them. The 

 cyst is developed, becomes infected and bursts 

 at the surface without having done much dam- 

 age. This is the most favorable of all the 

 fistulae of the withers to treat surgicall}^ On 

 the contrary, if the process is slow and there 

 is delay in pointing, and if no treatment is 

 instituted to relieve matters, the disease slowly 

 but surely encroaches into the adjacent struc- 



