46 FISTULA AND POLL-EVIL 
seat of the trouble as in the traumatic forms. 
This likelihood of fistulae 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 surgically. 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- 
