SEAT OF PRIMARY INVASION. 227 



later abscess was incised and nearly a pint of brownish pus having 

 a feculent odor escaped. Digital exploration revealed an irregular 

 cavity the walls of which at some points were plainly lined with 

 intestinal coils. Disinfection and drainage. As the symptoms did 

 not improve materially the abscess cavity was again scraped out and 

 disinfected four weeks later. After this operation it was noticed 

 that the pus contained yellow granules, which under the micro- 

 scope were shown to be actinomyces. The abscess was incised a 

 third time, but the patient showed no improvement, and died Octo- 

 ber 9th. The autopsy revealed primary actinomycosis of ascending 

 colon with multiple fistulous perforations, metastatic actinomycosis 

 of liver with perforation of one of the foci into the hepatic vein, 

 and multiple metastases in lungs. 



These observations warrant the opinion that the mucous mem- 

 brane of the intestinal canal is a frequent seat of primary localiza- 

 tion of the actinomyces, thus corroborating the statements made by 

 Johne in reference to this disease in animals. 



3. Inhalation actinomycosis. The case of actiuomycotic abscess 

 of the lung caused by the inhalation of an infected tooth, reported 

 by Israel, has already been cited as an illustration in showing that 

 decayed teeth frequently serve the purpose of an infection-atrium 

 in actinomycosis of the mouth. Cases of primary actinomycosis of 

 the lungs, however, have been observed in which no such carrier of 

 the contagium could be found, and in which infection must have 

 occurred by the direct inhalation of the fungus or its spores. 



Szenasy (" Ein Fall von Lungen-Aktinornykose," Centralblatt f. 

 Chirurgie, 1886, !N"o. 41) found, in the case of the wife of a butcher, 

 who had suffered for nine years from severe pain in the right side 

 of the chest, latterly attended by a severe cough in the right mam- 

 mary region, a fluctuating swelling the size of a hen's egg covered 

 with normal skin. On the outer side of this swelling, in the inter- 

 costal space between the third and fourth ribs, another swelling 

 existed double in size and elongated in shape and with indistinct 

 margins. This latter swelling had been noticed for nine years, and 

 was tender to the touch. Auscultation over the fourth and fifth 

 intercostal spaces on the healthy side revealed bronchial breathing 

 and diffuse bronchial rabies. Temperature 38.4 C. (101.1 F.). 

 Urine contained a trace of albumin. By aspiration one hundred 

 and fifty cubic centimetres of thick yellow pus were removed, which 

 contained colonies of actinomyces. Actinomyces were also found in 

 the sputum. The patient had carious teeth, but no signs of actino- 

 mycosis could be detected in the mouth. 



Canali (quoted by Partsch) communicates the clinical history of 

 a girl, fifteen years of age, who had suffered for eight years from a 

 cough, attended by a scanty fetid expectoration. Inspection and 



