536 
M. H. REYNOLDS. 
an old chronic, and was discharging freely from several open¬ 
ings. One sinus passed straight down beside the laminar por¬ 
tion of cervical ligament five inches and just in front of the 
anterior scapular borders. There were several short and 
superficial sinuses which I could lay open from top to bot¬ 
tom, but that deep sinus was a puzzle, owing to its peculiar 
location. The treatment decided upon was a long seton of 
rubber drainage tubing passed from the outlet diagonally 
downward, forward, and to the right a distance through and 
between muscles of fourteen inches. The shallow sinuses 
closed in twelve days. The long sinus and drainage tube 
were flushed out occasionally with mild antiseptic solutions. 
The tube was drawn down and clipped off an inch every 
other day. This process was required about five weeks and 
gave good results, for the sinus closed above as the tube was 
withdrawn. Notes show case D to have been dismissed June 
ist, 1891. September 23d a small abscess was formed on 
right side near the cervical and near the old outlet, which 
soon ruptured. The opening was slightly enlarged, and the 
cavity with its short sinus was filled with ninety-five per 
cent, carbolic acid. There was profuse discharge for a week, 
then rapid and permanent healing. October 15th D was 
sound again, and has so remained ever since. Here was a 
case of dormant pyogenic microbes becoming active after a 
locus minor is resist entice had been formed, perhaps b} 7 bruise 
or other tissue injury. Criticisms : 
( a ) A lesson-teaching incident occurred when the drain¬ 
age tube had been partly removed. A sudden swelling and 
stiffness of the front leg on that side occurred when the drain¬ 
age tube had been partly removed, evidently a septic inflam¬ 
mation. Vigorous examination by the probe discovered, and 
opened a large pus cavity at one side of the artificial sinus. 
My only explanation is that the broad-bladed seton needle 
passed through the body of the small complexus parallel with 
the muscle fibres, and when the seton was drawn below they 
closed and healed rapidly, confining pus above. 
( b ) I made a very grave mistake in opening the cyst as 
long as there was a possibility of securing absorption. 
