ACTINOMYCOSIS. 339 



In operating the animal is cast, the head placed on the side, and 

 the nose forced downwards. The operator works round the tumours, 

 always operating in the still healthy tissue, and removes the growth 

 as far as possible with the fingers, assisted by knife and scissors. 

 In this way severe bleeding is avoided, and small vessels can after- 

 wards be ligatured. For checking parenchymatous bleeding, Esser 

 and Preusse recommend the actual cautery, which has the additional 

 advantage of destroying at the same time any infectious material 

 that may have remained. The wound is washed out with carbolic- 

 solution, filled with some aseptic material (salicylic wadding, Esser), 

 and the skin sewn up. When the stitches are removed next day, 

 the parts are washed out with a disinfectant solution, and treated 

 as an open wound. Should the condition return, repetition of the 

 operation is seldom of any use. 



Injections of iodine tincture and 1 per 1000 sublimate solution 

 have been recommended, but are tedious and unreliable. In some 

 cases deeply incising the swelling and daily painting the surfaces 

 with undiluted iodine tincture is useful. Destruction of the fibrous 

 tissue of the growth with arsenic has been highly spoken of. Arsenic, 

 however, can only be used advantageously in the parotid region and 

 in cases where the growth does not extend to the larynx or pharynx. 

 Small solid fragments of arsenious acid weighing from 3 to 7 grains 

 are thrust into the midst of the growth in the direction of the hard 

 cord which can be felt extending into the depth. A passage can first 

 be made with round-pointed scissors, and the fragment of arsenic 

 inserted with slender forceps. Another method consists in incising 

 the skin, passing a fairly wide trocar and cannula to the base of the 

 growth, removing the trocar, inserting the fragment of arsenic 

 into the cannula, and thrusting it to the bottom by replacing the 

 trocar. The entire instrument is then withdrawn. In from six 

 to twelve weeks the diseased tissue sloughs away, leaving a wound 

 which heals by granulation. Working oxen may be used throughout 

 the treatment. Arsenic has also been used in the form of an 

 ointment. 



The internal use of potassium iodide has been warmly recom- 

 mended. One and a half to 2| drachms of the salt, dissolved in 

 water, are given daily. Under this treatment the swellings diminish, 

 but it must often be continued for many weeks before recovery is 

 complete. Moreover, success is not invariable, though the real 

 value of the treatment cannot be called in question. The other 

 methods can always be tried in case of failure. 



