224: ACTINOMYCOSIS HOMINIS. 



passed beyond the stage of granulation, presenting a more distinct 

 boundary-line between healthy and diseased tissues, a most important 

 factor in the operative treatment. The first case died from a recur- 

 rence of the disease in the vicinity of the operation wound and exten- 

 sion to the neck and chest, while in the second case the wound healed 

 and the patient has since remained in perfect health. 



fl. Intestines. In primary intestinal actinomycosis the disease 

 must be due to mural implantation of the fungus and infiltration 

 of the tissues by its progressive growth. Arrest and implantation 

 of the actinornyces are determined by antecedent pathological 

 changes. 



Chiari (" Ueber primare Darmaktinomykose des Menschen," 

 Prager med. Wochenschrift, No. 10, 1884) described the post-mor- 

 tem appearances in a case of primary intestinal actinomycosis. The 

 patient was a man thirty-six years of age, the most prominent 

 symptom being progressive marasmus. At the necropsy chronic 

 tuberculosis in the apices of the lungs and a few tuberculous ulcer- 

 ations in the lower portion of the ileum were found. The large 

 intestine presented a very remarkable appearance, the mucous 

 membrane of which, except the csecum and ascending colon, was 

 covered with whitish deposits, forming round and oblong patches 

 some of them one cubic centimetre in diameter, and five milli- 

 metres in thickness. In some of these patches could be seen 

 minute yellowish-brown and yellowish-green granules. The 

 patches were firmly adherent and when removed left a loss of sub- 

 stance in the mucous membrane. The mucous membrane through- 

 out was in a state of catarrhal inflammation. On microscopical 

 examination the granules proved to be actinornyces. The myce- 

 lium had penetrated into the tubular glands and showed calcified 

 club-shaped conidia. The calcification of the club-shaped extremi- 

 ties had undoubtedly prevented deeper penetration of the fungus. 

 No other organs presented evidences of actinomycosis. Hochen- 

 egg (" Fall von Actinomykose," Wiener med. Wochenschrift, No. 

 44, 1886) presented a case of actinomycosis to the Medical Society 

 in the person of a man forty-three years of age, who had sustained 

 an injury of the abdomen nine mouths previously, and had since 

 that time noticed a painful swelling at the seat of injury. In the 

 region of the umbilicus a fistulous opening formed which continued 

 to discharge a thin secretion in which actinomyces were constantly 

 found. The patient was very much emaciated and many of the 

 teeth carious. There was no swelling about the jaws or neck. 

 Examination of organs of chest and the sputum contributed no 

 additional information. The author expressed the opinion that 

 the inflammatory swelling caused by the contusion furnished the 



