48 FISTULA AND POLL-EVIL 
ent granulations that encroach slowly on its ca- 
pacity and without always showing any ten- 
dency to complete the process of cicatrization 
because 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 perpetuate 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 dolent 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 we say 
that fistula of the withers is due to necrosis of 
the ligamentum nuche, 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 will cicatrize as soon as the 
slough is removed, encysted or dissolved, pro- 
