35 6 
J. T. NATTRESS. 
function. He must have definite ideas of the location, cause 
and distribution of the larger blood-vessels and nerves if he 
would make very deep incisions and punctures, as he sometimes 
must do. It is very unpleasant to cut the dorsal superior cerv¬ 
ical, or even larger branches of the vertebrae, under several 
inches of muscular tissue. The lymphatic vessels call for some 
attention in this discussion, because of the special part they 
play in distributing certain pyogenic microbe bacteria. In 
external portions of the body they are arranged in two primary 
sets—superficial and deep/ 
Etiology . — The next question is that of cause and, like 
Darwin’s first drop of protoplasm, some points are not easily 
explained. In discussing this subject under the topics of origin, 
sources from whence these microbes are received, mode of en¬ 
trance, and factors which determine the location of the pre- 
fistular abscess, I wish to make the following remarks: That 
suppuration rarely or never occurs without the presence of 
pyogenic microbes or their products; that the initial abscess is 
usually the result of a local auto-infection; that fistula may be 
indirectly transmissible, due to any one or to a combination of 
several pyogenic microbes, and, therefore, not specific; that one 
attack gives no immunity, but predisposes to others; that ex¬ 
ternal injuries may serve to fix their location, but are not to be 
regarded as primary causes. 
Origin , Bacterial .—In the early days of antisepsis, when 
healing without pus was first demonstrated possible, we received 
the old dictum, “no micro-organism, no pus.” Since those 
days this question has been argued back and forth by the most 
eminent writers of the present day. Dr. Senn, in his “Surgical 
Bacteriology,” concludes that pus microbes are the essential 
causes of suppuration. Some admit that suppuration may occa¬ 
sionally be produced by deep injections of germfrer irritants 
like silver-nitrate, ammonia and turpentine. But I think the 
great majority of competent observers hold that the great and 
common cause is the presence and activity of pyogenic micro¬ 
organism in susceptible tissues, and that certain of these organ- 
