426 INFECTIVE DISEASES. 



that a condition of the lungs may occur as the result of actino- 

 mycosis, which from the naked-eye appearances may be mistaken for 

 "grapes" or " angleberries." It will be well also to remember in 

 connection with the above remarks, that extreme emaciation may 

 result in actinomycosis, producing a condition which, without a 

 post-mortem examination, would probably be attributed to tuber- 

 culosis, the animal being regarded as a " piner " or " waster." 

 If these possible fallacies are taken into account, the excessive per- 

 centage of tubercular cases so commonly reported will be very 

 considerably reduced. 



There is no evidence to show that the flesh of animals suffering 

 from actinomycotic tumours is unfit for human consumption. In 

 very severe cases it is unwholesome, but there is no evidence that 

 it can produce actinomycosis in man. 



MANIFESTATIONS OF ACTINOMYCOSIS IN MAN. 



(I.) Invasion by the Mouth and Pharynx. The fungus may gain 

 access through carious teeth, or wounds or fistulse of the jaw, and 

 very possibly by inflammatory processes in the pharynx and tonsils. 



The disease attacks the 'lower jaw most frequently. The tumour 

 is found in close connection with the bone, or in the sub-maxillary 

 or sub-mental regions, and also in the prse-tracheal region. It occurs, 

 though rarely, in the interior of the bone. 



In a case described by Israel, which occurred in a woman aged 

 forty-six, there was a small tumour about the size of a cherry 

 attached to the external surface of the lower jaw, with an opening 

 through which a probe could be passed into the bone. The tumour 

 was incised and scraped away, and a cavity discovered in the bone, 

 admitting a small sharp-spoon. Later, a further operation was 

 performed : the periosteum was detached, the cavity of the bone 

 enlarged, and the contents scraped out, consisting of granulation 

 tissue, fragments of bone, and the yellowish fungi. At the bottom 

 of the cavity the fang of the canine tooth was found. No return of 

 the growth occurred. 



The first cases of actinomycosis which were observed in America 

 were connected with the jaw. In 1884 Dr. Murphy described two 

 cases at Chicago. The first was that of a woman aged twenty-eight. 

 Two weeks previously she had suffered from severe toothache, with 

 swelling in the throat and great pain in swallowing. It disappeared 

 after poulticing, but she was again attacked with toothache, and a 

 swelling appeared on the angle of the jaw. on the left side. The 



