226 ACTINOMYCOSIS HOMINIS. 



revealed the presence of actinomyces in the granulation tissue, as 

 well as in the pus of the abscess cavities. 



But three cases of actinomycosis had been reported from Switzer- 

 land until Langhaus (Correspondenzblatt /. Sehweizerdrzte, June, 

 1888) recently increased this number by three more which came 

 under his own personal observation. One affected the rnastoid 

 region, while in the two others the entrance of the fungus took 

 place through the alimentary canal. In one of these latter cases 

 the process evidently started from the appendix vermiformis, which 

 was four centimetres in length, the end of which appeared as if 

 transversely cut in an abscess cavity the size of a walnut. The 

 abscess was on the right side of the bladder, and so deep in the 

 pelvis that during life it could not be located. The abscess pur- 

 sued a chronic course, and the walls were well defined ; no sign of 

 chronic or acute peritonitis. Furthermore, the mucous membrane 

 of the appendix was studded with cicatrices, and presented a slate- 

 color. The principal seat of the actiuomycotic process was in the 

 liver. The second case presented marked symptoms of perityphlitic 

 abscess during life. 



The necropsy showed perforation of the caecum and ascending 

 colon. No cicatrices in the mucous membrane or surrounding 

 tissues. In all probability the perforations occurred from without 

 inward. 



Lueniug and Hauau (Correspondenzblatt f. Schweizerdrzte, 1889, 

 No. 16) report a very interesting case of primary actinomycosis of 

 the colon, with metastatic deposit in the liver. The patient was a 

 man twenty-eight years of age, who in 1880 suffered from an acute 

 abdominal affection which at the time was diagnosticated as typhlitis. 

 Four years later he suffered from a second attack, which presented 

 the appearances of intestinal obstruction. He was very ill for eight 

 days, when the symptoms of obstruction subsided, and he made 

 a slow recovery. During the year 1887 he had a third attack, 

 attended by high fever and absolute constipation for eight or ten 

 days. During the month of December of the same year he had 

 another but less severe attack, and at this time a hard swelling 

 made its appearance in the right side of the abdomen. From this 

 time until he was admitted into the hospital, April 5, 1888, he was 

 confined to bed. The patient was at this time greatly emaciated, 

 with a temperature from 38.4 to 39.8 C. Swelling the size of a 

 fist in the right side of the abdomen half way between umbilicus 

 and anterior superior spine of the ilium. Externally this swelling 

 presented redness and oedema. Fluctuation indistinct. Deep pal- 

 pation showed that swelling extended to right hypochoudrium. 

 Abdomen not tympanitic. Swelling painful and tender, pain ex- 

 tending to spermatic cord and testicle on same side. A few days 



