SEAT OF PRIMARY' INVASION. 225 



necessary conditions for the localization of actinomyces from the 

 intestinal canal. 



Zemann ("Ueber die Aktinomykose des Bauchfells und der 

 Bancheingeweide beim Menschen," Wiener med. Jahresbericht, 

 Hefte 3, 4, 1883) reports five cases of actinomycosis of the abdo- 

 men. In four of them the disease commenced with sharp lanci- 

 nating pains in the abdomen, and during their course presented the 

 clinical picture of chronic peritonitis. Swellings could be found in 

 one or more places in the anterior abdominal wall, and the abscesses 

 were either incised or opened spontaneously ; in three cases they 

 communicated with the intestinal canal. 



The first case was a woman, thirty years of age, who had a fistu- 

 lous opening in the anterior abdominal wall, which communicated 

 with a swelling in the left parametrium. The patient stated that 

 this swelling appeared soon after her last childbed. A constant 

 discharge of yellowish- red pus was maintained, in which, under the 

 microscope, numerous actinomyces could be seen. The patient died 

 of exhaustion, and at the post-mortem chronic parametritis and 

 perimetritis were found, with extensive pus cavities which commu- 

 nicated with the rectum and bladder. The second case occurred in 

 a person eighteen years of age, who, during life, had suffered from 

 a large abscess in the abdominal cavity under the right lobe of the 

 liver, which communicated with the intestinal canal and had led to 

 numerous fistulous openings in the anterior abdominal wall. At 

 the necropsy a loop of the ileum was found perforated and in com- 

 munication with the abscess cavity. The pus contained numerous 

 actinomyces. In the third case the diagnosis was made post-mortem 

 by the discovery of actinomyces in the pus. The disease was located 

 in the lower portion of the ileum and caecum, where it had caused 

 suppuration and numerous adhesions. 



The most remarkable and interesting history is connected with 

 the fourth case. A robust, well-nourished woman, forty years of 

 age, was attacked quite suddenly with pain in the stomach, high 

 temperature, diarrhoea, and vomiting, followed by cerebral symp- 

 toms and death. At the necropsy the right Fallopian tube was 

 found transformed into a large abscess, both extremities of tube 

 closed, walls of sac lined with granulations containing actiuomyces. 

 The fifth patient was fifty years of age, and had suffered for a long 

 time from lancinating pain in the abdomen ; a fistulous opening 

 formed in the umbilical region and discharged a thin, yellowish- 

 green pus. The post-mortem showed actinomycosis of the peri- 

 toneum, small intestine, left ovary and liver, large abscess among 

 intestinal coils, perforation of small intestine and bladder. In the 

 upper part of the small intestine small pigmeuted cicatrices were 

 found. In all of the above cases the microscopical examination 



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