18 FISTULA AND POLL-EVIL 



ent granulations that encroach slowly on its ca- 

 2)acity and without always showing any ten- 

 dency to complete the process of cicatrization 

 hecause they must sprout largely from a poorly 

 nourished matrix (the ligament) which now 

 dies in foci here and there, and then sojourns 

 only as a foreign agent to ])erpetuate the 

 process indefinitely. The ligament, contrary 

 to the generally accepted conclusion, is never 

 found entirely dead, except in very old and ex- 

 ceptional cases; it undergoes only focal 

 necrosis at different spots, retaining enough 

 vitality to delay sequestration, and all of the 

 while sprouting out with indolent granulations 

 over its viable zones. The granulations are in- 

 capable of maturing into scar tissue because of 

 the dead zones protruding here and there 

 among them and because they are poorly nour- 

 ished. Thus we must not suppose when w^e say 

 that fistula of the withers is due to necrosis of 

 the ligamentum nuch^, that the ligament is 

 immediately dead and that as a dead object 

 perpetuates the disease right from the begin- 

 ning. Fistula on the contrary is due to the slow^- 

 ly dying process of the ligament, to its stub- 

 born viability rather than to its death. Once 

 dead, however, and separated from the living 

 part, the cavity w^ill cicatrize as soon as the 

 slough is removed, encysted or dissolved, pro- 



