178 An Introduction to Medical Mycology 



vigorous treatment is curative, or become generalized in extent, when it may 

 cause the death of its host. The disorder was described and named by Bol- 

 linger, while in the same year ( 1877 ) Harz named the organism producing 

 the disease, A. bovis. This organism was first cultured and carefully studied 

 by Wolff and Israel. Bostroem found the fungus in diseased cattle. Murphy 

 and Ruhrah first reported the disease in the United States. Blain estimated 

 that about 1,000 cases of actinomycosis have been reported in this country 

 and concluded that the actual number of cases in the population is many 

 times as great. 



(a) Incubation period.— This is not definitely known, but it is probably 

 only a few days or weeks. 



(b) Etiology.— Several fungi have been considered as the causative or- 

 ganisms. It is generally agreed now that in many if not all cases actinomy- 

 cosis proper is caused by A. bovis (Harz; Wolff, and Israel). The disease is 

 more prevalent in farming country than in urban districts; nearly half 

 the patients suffering from this disease are engaged in agricultural pur- 

 suits. Wild and domestic animals (particularly cattle) are susceptible to 

 the infection. However, inoculation of cultural material of A. bovis into 

 animals never completely reproduces the disease. In half the cases no infec- 

 tion results, and even when inoculation is successful only insignificant 

 lesions appear. Adults are affected more commonly than children and males 

 much more often than females ( approximately 2:1). Actinomycosis bovis has 

 been isolated from the normal mouth and throat and is probablv frequently 

 present in the mouth, throat and gastrointestinal tract of healthy human 

 beings and animals. Emmons found granules containing Actinomyces 

 in 47 per cent of the tonsillar crypts in a series of 100 consecutive tonsil- 

 lectomies; in approximately half of these, a growth was obtained of a 

 microaerophilic Actinomyces considered to be A. bovis. Trauma is un- 

 doubtedly a frequent precipitating factor, and cases of infection following 

 extraction of teeth and resulting from bites are not uncommon. There is a 

 possibility that the saliva and the nasal discharges may also be responsible 

 for its transmission. 



(c) Clinical characteristics.— According to Steinbach, the disease in 

 human beings has four anatomic localizations: (1) head and neck, 50 per 

 cent; (2) abdominal organs, 20 per cent; (3) thoracic organs, 15 per cent, 

 and (4) other organs, including the skin, 15 per cent. Cope's statistics arc 

 in virtual agreement. The infection may spread by continuity or by means 

 of the blood stream to involve any part of the body. 



(/) Head and neck.— The primary lesion may often be detected in the 

 buccal mucous membrane. The gums, the tonsillar crypts or other parts 

 of the mouth mav be involved, the infection traveling to the subcutaneous 



