PATHOGENESIS 115 
During this stage the patient becomes sick 
and severely 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 microdrganism. 
These exert a more or less destructive influence 
upon the ligamentum nuche, 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 
