2L8 ACTINOMYCOSIS HOMINIS. 



The product of inflammation around each fungus consists of granu- 

 lation tissue, which resembles tubercle tissue. At first the cells are 

 round, at a later stage of the inflammation epithelioid and giant 

 cells are formed immediately around the fungus. As the disease 

 is almost always attended by suppuration at some time during its 

 course, it has been customary to ascribe to the actinomyces pyogenic 

 properties. Israel has always held that the actinomyces is a pus- 

 producing fungus, in opposition to Ponfick and some other patholo- 

 gists, who claim that when suppuration takes place it is the result 

 of a secondary infection with pus-microbes. As cases of actinomy- 

 cosis have been reported which remained stationary in the granula- 

 tion stage for an indefinite time without suppuration taking place, 

 and pus-microbes have been cultivated from the pus of actinomy- 

 cotic abscesses, it appears more than probable that suppuration 

 occurred independently of the presence of the fungus, and was pro- 

 duced by the specific action of pus-microbes on the granulation 

 tissue. Firket (Revue de Mgdecine, 1884) asserts that the actino- 

 myces does not appear to produce u coagulation-necrosis/' but from 

 a study of the earliest formed colonies he finds that the first eifect 

 of the fungus is to induce cellular hyperplasia. It is as if the tissue 

 elements resented the intrusion of the parasite, which, however, 

 mostly gains the upper hand, so that the result is the formation of 

 granulation tissue, and, later, abscesses that characterize the disease. 

 As a rule, it may be stated that the earlier suppuration takes place 

 the more rapid the spread of the disease and the graver the prog- 

 nosis, while the absence of suppuration indicates comparative be- 

 nignancy, and points in the direction of a more chronic form of the 

 affection. The localized chronic form of actinomycosis resembles 

 in its clinical features and its anatomical locations more closely 

 sarcoma than any other affection. In such cases it would be diffi- 

 cult, if not impossible, in the absence of the specific fungus, to make 

 a differential diagnosis between it and round-celled sarcoma, even 

 by a most careful microscopical examination, as the histological 

 structure of both is almost identical. 



CLINICAL HISTORY. Usually the disease follows quite a 

 chronic course and the swelling at the seat of primary localization 

 resembles in its clinical history more a tumor than an inflammatory 

 swelling. The extension of the morbid process takes place by dif- 

 fusion of the actinomyces in loco, in preference along the loose 

 connective-tissue spaces, each fungus constituting a nucleus for a 

 nodule of granulation tissue. By confluence of many such nodules 

 the inflammatory swelling often attains a very large size, and when 

 suppuration occurs in the interior the further history is that of 

 abscess. Diffusion never takes place along the course of lymphatic 

 vessels and glands. When these structures are affected in the 



