PATHOGENESIS 115 



During this stage the patient becomes sick 

 and severeh^ hindered in the movements of the 

 head. It becomes manifestly opisthotonic in 

 attitude, and develops a body temperature of 

 from two to three degrees above normal. The 

 poll becomes progressively more painful to the 

 touch and the sides of the neck are streaked 

 with radiating lines. 



The Fistulous Stage 



Either by lancing or by spontaneous ripping 

 and bursting of the abscess this stage sooner or 

 later passes into the stage of chronic discharge 

 — fistula. If the infection is not a virulent one 

 the development is very slow — cold abscess — 

 and fibrosis becomes a prominent feature of the 

 process. That is to say, if the accumulating 

 pus is not released the process reacts upon the 

 surroundings in some way that causes the mus- 

 cular elements to become fibrous. 



The fistulous and the phelgmonous stages 

 are of course influenced by microorganism. 

 These exert a more or less destructive influence 

 upon the ligamentum nuch«, which is in the 

 center of the theater of attack. Once this fibro- 

 elastic structure has been damaged it acts as 

 the underlying cause of subsequent pathologic 

 processes. Riddled with perforations, shred- 

 ded with bundles of its fibers which remain 



