CLINICAL APPEARANCE IN MAN 373 



vegetable particle acted as a foreign body about which the fungus 

 grew. Actinomyces bovis has never been found on such material 

 except when it is present in lesions. The organism does occur in the 

 oral cavity as a saprophyte, however. 



In cattle the disease occurs most frequently in the mouth parts, 

 usually the tissues about the teeth and in the jaw bones. Lesions in 

 the tongue, frequently called woody tongue on account of the indura- 

 tion of tissues, are usually those of actinobacillosis. Lignieres and 

 Spitz, 1^ and IMagnusson,^^ and others have pointed out this clinical 

 differentiation. 



Actinomycosis of the jaw bones, lumpy jaw, occurs through in- 

 vasion of the tissues of the jaw bone by way of the peridental mem- 

 brane. The organisms may extend from carious teeth or may be 

 carried from the tooth or membrane surfaces into the soft tissues by 

 hard food particles during chewing. By extension through the tissues 

 between the tooth and the alveolar processes the jaw bone becomes 

 involved. The disease may be confined to the periosteum in some 

 cases, but usually involves the bone marrow itself. The growth of 

 the parasite gives rise to very characteristic tissue changes. In the 

 immediate vicinity of the organism the bony tissue is destroyed and 

 an abscess is formed. Between these abscesses there is an overgrowth 

 of bony tissue. As a result of these two processes there is formed a 

 large swelling on the jaw bone, composed of new bone tissue which is 

 honeycombed in all directions so that it has a spongy texture. 



The abscesses in the bone finally break through to the exterior 

 either into the mouth or on the skin surface, forming fistulae which 

 discharge pus. 



Primary lesions of the lungs and of the intestinal tract also occur 

 in cattle but are not nearly so frequent as those of the mouth parts. 

 Clinical Appearance in Man. In man the disease has been known 

 to involve all parts of the body, but it occurs as a primary lesion 

 most frequently in the neighborhood of the face and neck. Second 

 in frequency are primary lesions of the abdominal cavity, and third 

 the cases primary in the lungs. 



Cervico-facial actinomycosis in man usually originates in the 

 mouth parts and many cases follow neglect of carious teeth, tooth 

 extraction, jaw fracture, or other accident in which the organism 

 present as a saprophyte in the oral cavity is introduced into the 

 tissues. The jaw bone is not so frequently involved as in cattle. 

 The infection spreads through the soft parts causing a brawny or 

 board-like induration. Infection is usually somewhat more acute 



