228 ACTINOMYCOSIS HOMIXIS. 



percussion yielded only negative results. Auscultatory symptoms 

 pointed to a diffuse catarrh. Under the microscope the sputum was 

 seen to contain pus corpuscles, epithelial cells, and numerous actino- 

 myces. No primary source of infection could be found in the 

 mouth, pharynx, or nose. Other cases of primary actinomycosis of 

 the lung have recently been reported by Laker (" Beitrag zur Char- 

 akteristik der primaren Lungen-Aktinomykose," Wiener med. Presse, 

 1889). Lindt ("Ein Fall von primarer Lungenspitzen-Aktinomy- 

 kose," Schweiz. Correspondenzblatt, Nos. 9-12, 1889), and Butimeyer 

 (" Ein Fall von primarer Lungen-Aktinomykose," Berl. klin. 

 Wochenschrift, No. 3, 1889). In all of these cases the disease 

 proved fatal by the extension of the actinomycotic process, followed 

 by the formation of large abscesses. In Lindt's case the disease ex- 

 tended from the lungs to the muscles of the neck. Moosbriigger 

 interprets the mechanism of the ingress of actinomyces by assuming 

 that the fungus enters the bronchial tubes during inspiration, and 

 becomes at first deposited upon the mucous membrane, in which its 

 presence and growth cause a destruction of the epithelial cells, when 

 it reaches the submucous and peribronchial tissues, in which a nodule 

 of granulation tissue is produced, which by pressure induces degen- 

 erative changes and gradual destruction of the bronchial wall for 

 further infection. He believes that the peribrouchial lymphatic 

 vessels and glands take an active part in 'the local diffusion of the 

 process, as they furnish an avenue for the distribution of the germ 

 or its spores. He claims the existence of an actinomycotic lymph- 

 angitis, but confesses that he has never seen the fungus inside of 

 lymphatic vessels. As soon as the fungus reaches the pulmonary 

 tissues it gives rise to parenchymatous inflammation, the first pro- 

 duct of which is always granulation tissue, which, at a later stage 

 and under the influence of a secondary infection with pus-microbes, 

 undergoes transformation into pus corpuscles and the formation of 

 abscesses. 



ACTINOMYCOSIS OF BRAIN. Bollinger has placed on record 

 the first case of primary actinomycosis of the brain ( " Ueber 

 primare Aktinomykose des Gehirus beim Menschen," Munch- 

 ener med. Wochenschrift, 1887, No. 41. The patient was twenty- 

 six years of age. The intra vitam diagnosis was tumor of the 

 brain ; the most prominent symptoms were severe headache, 

 paralysis of the left abducens, congestion of optic papilla, and 

 momentary unconsciousness. The swelling in the brain, found on 

 autopsy, presented the characteristic features of a cysto-myxoma in 

 the third ventricle ; all of the ventricles were found considerably 

 dilated. The swelling contained numerous colonies of actinomyces 

 in all possible stages of development. The tendency to suppuration 

 of the tissues usually found in all cases of actinomycosis in man was 



