220 ACTIXO MYCOSIS HO MINIS. 



lower jaw, mouth, and throat were affected ; in 9 the upper jaw 

 and cheek ; in 1 the tongue ; in 2 the region of the oesophagus ; in 

 11 the intestines ; in 14 the bronchial tract and the lungs ; in 7 the 

 point of entrance could not be ascertained. lufectiou may take 

 place through any abraded surface brought in contact with the 

 specific cause, aud for clinical purposes the cases can be divided 

 into the following three groups : 1. Cutaneous surface. 2. Ali- 

 mentary canal. 3. Kespiratory tract. 



1. Cutaneous surface. Partsch (Deutsche Zeitschrifif. Chirurgie, 

 B. 23, p. 498) describes a case of actinomvcosis in which the dis- 

 ease developed in the scar left after extirpation of the breast. The 

 patient was a man, aged sixty. In June, 1884, his left breast was 

 removed for an ulcerating carcinoma. As the wound did not heal 

 by primary union and the process of cicatrization was very slow, a 

 number of small skin-grafts, from a perfectly healthy young man, 

 were transplanted. The wound was practically healed in Septem- 

 ber. Two months later, the cicatrix ulcerated and an abscess dis- 

 charged itself. Actinomyces were found in the pus. The parts 

 were excised, and the progress of the disease was apparently arrested. 

 No explanation could be made how the infection occurred. 



Hochenegg reported a case of actiuomycosis of the skin of the 

 left submaxillary region, in which he attributed the disease to an 

 invasion of the fungus through a small atheroma. 



Kaposi (Wiener med. Wochenschrift, Nos. 19-22, 1887) reports 

 a very chronic case of actinomycosis which primarily started in the 

 skin. When first noticed, it appeared as a red spot the size of a 

 florin on the left pectoral muscle, which gradually increased to the 

 size of a walnut, and then gradually flattened down and disap- 

 peared. Meanwhile fresh spots and lumps appeared, some as large 

 as a pigeon's egg. Eleven years after the beginning of the disease 

 a swelling as large as an apple appeared over the spine of the sixth 

 vertebra, which gradually extended forward and a year later formed 

 a large swelling behind the right axilla. A year later, this swell- 

 ing had diminished in size to that of a pigeon's egg, and then again 

 increased in size. Ulceration set in, exposing a fungous bleeding 

 surface. At this time the entire trunk, but not the limbs, was 

 covered with nodules, spots, and stripes. The swellings were 

 heaped in masses. The infiltration was located in the corium. In 

 this case it appears that secondary infection with pus-microbes 

 only occurred at the points of ulceration. 



At the meeting of the German Society of Surgeons in 1889, 

 Leser (Klinisclier Beitrag zur Aktinomykose des Menschen) reported 

 three cases of primary actinomycosis of the skin which had come 

 under his own observation in the course of a single year. In his 

 remarks on this subject he placed special stress on the manner in 



