ACTING MYCOSIS OF BEAIX. 229 



entirely absent in this case. This case, if any, appears to be one of 

 crypto-genetic infection, as the fungus or spores must have entered 

 somewhere through the cutaneous or mucous surface without pro- 

 ducing the disease at the portio invasionis, and, localizing in the 

 brain by embolism, produced primary actinomycosis in this organ. 

 Keller (British Medical Journal, March 2 ), 1890) reports a case 

 of actinomycosis of the brain secondary to same disease in chest- 

 wall in which a correct diagnosis was made during life, and an 

 operation performed followed by temporary improvement. The 

 patient was a woman, forty years of age, who suffered from pleurisy 

 followed in six months by an abscess over the cartilage of sixth 

 rib and also the eleventh. Both were incised, contents removed 

 by sharp spoon, and drained. They did not communicate with the 

 pleural cavity, nor were the ribs affected. These abscesses healed, 

 leaving one small fistula. Two years later she complained of 

 increasing paresis of left arm. Diagnosis of actinomycosis in the 

 motor area was made, but patient declined operation. Convulsions 

 of the left arm soon set in several times taking the course of corti- 

 cal epilepsy. The paresis extended to left lower extremity and left 

 side of the face. Headache, vomiting, and complete loss of con- 

 sciousness followed, which developed into deep coma, and when 

 apparently moribund operation was consented to. Dr. Burger, 

 without any anaesthetic, trephined the skull over the middle of the 

 right ascending parietal convolution, incised the dura mater and 

 discolored brain substance and removed two ounces of thin greenish 

 pus which contained great quantities of actinomyces. Soon after 

 opening the abscess she recovered from the deep coma, and called 

 for water. On the following day consciousness returned. On the 

 eighth day facial paralysis disappeared and she could move the leg. 

 Six months after the operation she began to walk around. During 

 the next few months, the paralytic lesions materially improved, 

 but there still remained paresis of left arm and slight contraction 

 of the fingers. In two months the wound had healed, and the 

 patient felt very well. Several (eleven) months later, grave symp- 

 toms of increasing paralysis, headache, and convulsions returned. 

 Dr. Burger reopened the brain and removed a considerable quantity 

 of pus. This was followed by no material improvement, and the 

 patient died a few days afterwards. At the post-mortem the 

 middle third of the right frontal and parietal convolutions was 

 occupied by a large mass of newly-formed tissue protruding over 

 the surface of the brain, reaching down into the substance of the 

 brain for one inch. Underneath it, deeply buried in the white 

 substance, an unopened encapsulated abscess the size of a nutmeg 

 was discovered. 



