V ACTINOMYCOSIS. 357 



tive tract, and most frequently, probably, carious teeth, or 

 the wound left after extraction of a tooth. The frequent 

 occurrence of the disease in the neighborhood of the jaw, 

 and upon the neck, is suggestive of this site of invasion, 

 although any other part of the body may constitute the 

 portal of entry. Cases of actinomycotic perityphlitis have 

 been reported, and Chiari has recorded one of primary 

 actinomycotic disease of the intestinal mucous membrane 

 in an insane person, and the like. It is certain that an 

 injury of the skin or of the affected mucous membrane is 

 necessary for infection to take place. The source of the 

 infecting actinomyces-material is, however, only rarely 

 demonstrable. The chewing of wheat-grains is often 

 assigned as a cause. Some observers suggest the possi- 

 bility of direct transmission from cattle, although this has 

 not yet been demonstrated. In a considerable number of 

 cases of actinomycosis a history of any industrial or acci- 

 dental association with cattle is completely wanting. 



The course of actinomycosis is exceedingly insidious. 

 The extension of the chronic inflammatory process that 

 attends the vegetation of the fungus can be restrained only 

 by complete removal of the latter. The disease frequently 

 'leads to death, from the invasion of vital internal organs 

 (kidneys, lungs, etc.) by the fungous vegetation. Fre- 

 quently, secondary acute inflammation, amyloid degen- 

 eration, etc., are superadded. Secondary infection with 

 the excitants of suppuration appears especially common. 

 The extensive phlegmons, and especially the pyemia, which 

 often complicate the disease, can be attributed to this 

 source, although thorough investigations in this connection 

 are wanting. 



The question has not yet been studied whether the 

 actinomyces is capable of generating toxic substances and 

 whether it gives rise in the body to intoxication, or whether 

 its action is purely mechanical that is, whether it impairs 

 the functions of organs by invading their structure. It 

 is noteworthy in this connection that some severe cases 

 of actinomycosis are entirely unattended with fever. 



Pure culture of the actinomyces has been attained by 

 M. Wolff and J. Israel (1890). These investigators cultivated 

 the ray-fungus in the absence of air, both upon agar and in 

 hens' eggs. Upon the surface of agar there form at a tern- 



