SEAT OF PRIMAEY INVASION. 219 



course of the disease, they indicate that secondary infection has 

 taken place. In some instances the disease pursues such a rapid 

 course that it may be mistaken for an acute phlegmonous inflam- 

 mation, osteomyelitis, or, when diffused over a large surface of the 

 body, for syphilis. A good illustration of the former class is fur- 

 nished by the case reported by Kapper (" Ein Fall von acuter 

 Aktinomykose," Wiener med. Presse, No. 3, 1887). A soldier, 

 twenty-two years of age, became suddenly ill with febrile symp- 

 toms and a rapidly increasing swelling of the lower jaw. An early 

 incision was made and liberated a large quantity of pus, which, on 

 microscopical examination, was found to contain actinomyces. It 

 is interesting to note that in this case the carious teeth, from where 

 the infection had evidently taken place, contained threads of lepto- 

 thrix and actiuomyces. At a meeting of the Berlin Medical 

 Society, O. Israel (Berliner Ein. Wochenschrift, Jan. 23, 1888) gave 

 an accurate description of the post-mortem appearances of a case of 

 diffuse actinomycosis. The patient, a woman, forty- four years of 

 age, had been treated for syphilis in one of the surgical clinics. 

 The heart contained a number of minute abscesses in which the 

 fungus could be found in large numbers. A large abscess between 

 the diaphragm, stomach, and spleen contained thick pus of a 

 greenish color, an unusual occurrence in cases of actinomycosis, but 

 no actinomyces. The spleen was the seat of a large and of numerous 

 minute abscesses, and the liver and kidneys also contained small 

 abscesses, and in all of them actinomyces could be found. Israel 

 claims that this case furnishes a good illustration of his views, that 

 the actinomyces, as regards its effect on the tissues, occupies a posi- 

 tion half-way between the bacillus of tuberculosis, which produces 

 only granulation tissue, and the pus-microbes, which produce pus. 

 It was impossible in this case, as in so many others in which mul- 

 tiple deposits have been found, to locate the primary seat of infec- 

 tion. The teeth were perfect and the whole digestive tract showed 

 no evidences of disease. 



SEAT OF PRIMARY INVASION. If infection takes place by fully 

 developed actinomyces, it can only do so by the fungus gaining 

 entrance into the tissue through some loss of continuity in the 

 cutaneous or mucous surface, as any other method of ingress is 

 impossible on account of the large size of the fungus, in the cases 

 in which no such primary infection-atrium could be found, it must 

 be taken for granted that the local lesion had healed between the 

 time infection took place and the first manifestations of the disease, 

 or that infection was caused by the entrance of spores, which from 

 their smaller size could find their way into the tissue through intact 

 mucous surfaces. In reference to the primary localization of the 

 disease, Moosbrugger gives the following statistics : In 29 cases the 



