CHAPTER XX. 



ACTINOMYCOSIS HOMINIS. 



ALTHOUGH the parasite which is the direct cause of this disease 

 is Dot, properly speaking, a microorganism, as its presence in some 

 cases can be detected by the naked eye, I shall include it in the 

 list of surgical diseases due to the presence of microbes, as it often 

 requires the aid of the microscope to make a positive differential 

 diagnosis between this and other chronic infectious diseases charac- 

 terized by the presence of granulation tissue. 



HISTORY. The disease as occurring in cattle was first described 

 by Bollinger (" Ueber erne neue Pilzkrankheit beim Riude," 

 Centralblatt fur die medicinischen Wissenschaften, No. 27, 1877) in 

 1877, as a condition in which sarcoma-like tumors were met with, 

 associated with a peculiar growth which, from its structure, was 

 named Strahlenpilz (ray-fungus), or actinomyces. James Israel 

 (" Neue Beobachtungen auf dem Gebiete der Mykosen des Men- 

 schen," Virchow's Arehiv, Bd. Ixxiv., 1878) was the first to recognize 

 the disease in man, but it was not generally understood until the 

 appearance of the classical work of Ponfick (Die Aktinomykose des 

 Menschen, Berlin, 1882) in 1882. Numerous articles on this sub- 

 ject have since appeared in the current medical literature, so that 

 Partsch some two years ago brought at the end of his mono- 

 graph (" Die Aktinomykose des Menschen vom klinischen Stand- 

 pun kte besprochen," Sammlung klinischer Vortrdge, Nos. 306 and 

 307, 1888) seventy-five references with a supplemental list contain- 

 ing thirty-three names furnished by Schuchardt. Since the publi- 

 cation of Israel's case numerous cases have been reported by different 

 observers representing Germany, England, Belgium, Switzerland, 

 Russia, Austria, and America, so that Partsch, in the work referred 

 to above, estimates the whole number at not less than one hundred. 



While most of the articles in medical journals contain only a 

 description of isolated cases, it appears to have been the good for- 

 tune of some of the writers on this subject to meet with a number 

 of cases in a comparatively short time. Thus Hochenegg (" Zur 

 Kasuistic der Aktinomykose des Menschen." Wiener med. Presse, 

 Nos. 16 and 18, 1887) reports in his paper seven cases, and Moos- 

 briigger (" Ueber die Aktinomykose des Menschen," Bruins' 

 Beitrdge zur klinischen Chirurgie, Bd. ii. Heft. 2, S. 339, Tiibin- 



