374 ACTINOMYCOSIS 



than in bovines, suppuration being more pronounced, and overgrowth 

 of granulation tissue less so. 



Abdominal actinomycosis occurs much more frequently in man 

 than in cattle. A large proportion of cases apparently have their 

 origin in the neighborhood of the appendix or cecum, and lead to the 

 development of walled-off pericecal abscesses. Such cases are fre- 

 quently operated upon for chronic appendicitis or appendiceal ab- 

 scess, and show a pronounced tendency to drain pus for some time. 

 A rather large number of cases involving the internal female genital 

 organs are on record.^ In at least some of these cases the primary 

 lesion apparently was appendiceal. Primary abdominal lesions fre- 

 quently result in secondary liver abscesses, and there are some cases 

 of actinomycotic liver abscess in which no primary lesion in the 

 abdomen can be demonstrated. Abdominal actinomycosis is possibly 

 contracted by swallowing tonsillar granules containing the fungus, 

 or infected material from carious teeth, which lodge in the appendix. 



Primary pulmonary actinomycosis may develop when the fungus is 

 inhaled. In some cases the pulmonary lesions are secondary to 

 lesions of the mouth parts. Lesions of the lungs vary in character 

 from a subacute bronchopneumonia to a chronic disease resembling 

 tuberculosis with the development of cavities. 



A few cases appear to be primary in the subcutaneous tissues. In 

 some of the cases so reported one is led to question the diagnosis since 

 the anaerobe was not isolated. Such cases may have been actually 

 nocardiosis. In actinomycosis the skin lesions are usually secondary. 



Any suppurative inflammatory reaction which stubbornly resists 

 treatment, but tends to discharge continuously, should lead one to 

 suspect the possibility of actinomycosis. 



Diagnosis. The diagnosis of actinomycosis is established by find- 

 ing the organism in the pus in the form of very characteristic sulphur 

 granules (in German, DrusenI, or in the form of Gram-positive 

 branching hyphae or diphtheroid hyphal fragments. The granules 

 vary greatly in size, the larger ones being distinctly visible to the 

 naked eye. They have a radiating lobulated structure which is quite 

 characteristic. AVhere much pus is available, they are best searched 

 for by diluting the pus somewhat and straining through several layers 

 of gauze. The larger granules will be caught on the gauze and may 

 be removed for examination. With smaller amounts it is better to 

 spread the diluted pus in a Petri dish and go over it with a hand 

 lens. With still smaller amounts, a wet microscopic preparation can 

 be made by placing the pus on a microscope slide under a cover slip 

 for direct examination. If the pus is very thick it can be mixed with 



