338 ACTINOMYCOSIS. 



contents may show through. Incision liberates a thick, muco- 

 purulent fluid, in which careful examination discovers the characteristic 

 yellow grains. If not opened, the tumour breaks spontaneously. 

 Cicatricial contraction very seldom brings about healing. As a rule, 

 the growth proceeds, sooner or later producing, according to its 

 position, functional disturbance, difficulty in swallowing, dyspnoea, 

 and finally, in consequence of advancing exhaustion, death. The 

 swellings in the parotid region occasionally attain a great size, some- 

 times becoming as large as a child's head, but such growths require 

 several months. From the wound made by opening the abscess, 

 grows a soft, dark-red mass of granulation tissue, which bleeds 

 readily, and contains large quantities of the specific parasites. 



Prognosis must depend on whether the new formation can be 

 completely removed, which is seldom the case. Lasting improve- 

 ment can only be expected where treatment has been commenced 

 early, that is, before infection has become general, and treatment 

 is more successful in disease of the skin or subcutaneous tissues than 

 where deeper-seated structures or the pharynx or tongue are involved. 

 Disease of the bones of the upper or lower jaw, said by Esser and 

 others to arise from the first molars, is always very intractable. 

 Reference should be made to the sections dealing with these structures. 

 Cases affecting the parotid region, unless recent, are generally regarded 

 as hopeless. Whilst Esser supports this view, Preusse has observed 

 recovery in forty-one out of forty-five animals. It is of prime 

 importance to remove the tumour early, before it has attained, say, 

 the size of the hand, and while it is still circumscribed. If left longer, 

 the growth recurs, even after careful removal. The results of treat- 

 ment with potassium or mercuric iodide have proved so remarkably 

 favourable, and been so well spoken of by different practitioners, 

 that the prognosis of this disease must now be looked on as much 

 more hopeful than formerly. 



Treatment. Prophylaxis demands the avoidance of suspicious 

 fodder ; but this is troublesome and scarcely practicable, on account 

 of the difficulty of recognising whether such suspicious materials are 

 infected with actinomyces. In dealing with cattle it may be possible 

 to steam or boil most of the food, and special care must be taken 

 that the abscesses and their contents do not contaminate any food. 

 Although direct infection has not been clearly proved, actinomycosis 

 occurs in man, and veterinarians and those handling infected subjects 

 should hence exercise due caution. 



Of the various methods of treatment, operation is certainly the 

 oldest. It consists in total extirpation of the infected connective tissue. 



