680 INFECTIOUS DISEASES. 



It is otherwise with regard to growths in the pharynx and oesophagus, 

 for, until after removal, simple polypi cannot be distinguished from 

 actinomycotic growths. In such cases the administration of iodide of 

 potassium affords valuable indications. 



The prognosis is grave, whatever the clinical form of the disease. 

 Important advances, it is true, have lately been made, and the iodide 

 of potassium treatment is of great value, but too much must not be 

 expected of it, and its benefits have certainly been exaggerated. Clinical 

 experience suffices to prove that only actinomycosis of soft tissues can 

 be cured by drugs, bony lesions being amenable only to medical and 

 surgical treatment combined. Even combined treatment is often un- 

 successful. 



Treatment. Thomassen in 1885 first explained the favourable action 

 of iodide of potassium on actinomycotic growths, and Nocard in 1892 

 again directed public attention to the advantages attending the use 

 of this drug both in man and the lower animals. As too frequently 

 happens, however, the benefits of this treatment have been exagge- 

 rated, and iodide of potassium has been held out as a specific even 

 against lesions in bone. With very few exceptions this is incorrect, and, 

 as Moussu has shown, when the disease affects bone tissue it only 

 yields to mixed treatment. 



The treatment of actinomycosis may therefore be considered under 

 two heads. 



Firstly, the treatment of actinomycosis of soft tissues ; and, secondly, 

 that of bone. 



Actinomycosis of soft tissues, muscle, sldn, lymphatics, serous mem- 

 branes, etc., comprises the most common forms of actinomycosis, viz., 

 those of the tongue, pharynx, parotid glands, neck, etc. 



The second form comprises actinomycosis of the lower jaw (molar 

 region), the upper jaw, region of the incisors, etc. 



Iodide of potassium in daily doses of from 2 to 3 drachms is almost 

 a specific in dealing with the first form of disease. 



In lingual actinomycosis, for example, the effects may be seen a 

 few days after treatment is begun. The tongue becomes softer and 

 more mobile, can be protruded beyond the mouth and retracted into it, 

 and day by day tends progressively to resume its normal appearance. 



The patients, which were previously slowly dying of inanition be- 

 cause they were unable to feed themselves, again take to their food 

 and begin to put on flesh. To ensure the treatment being efficacious 

 it should, as a rule, be continued for three or four weeks. 



During the course of this treatment the system becomes saturated 

 with the drug, but no bad effects follow. The patients suffer from 

 lachrymation, coryza, bronchorrhsea, and especially iodic eczema, but 



