428 INFECTIVE DISEASES. 



destroying bones and even reaching the brain ; or the growth may 

 descend by the spinal column, implicating the vertebrae, and travel- 

 ling and pointing in various directions. 



(II.) Invasion by the Respiratory Tract. In one recorded case 

 the disease existed for seven years, was localised to the bronchi 

 (Bronchitis actinomycotica), and did not extend into the lungs. 

 The sputum was examined, and contained the characteristic fungus. 



If the micro-organisms are inhaled they pass into the bronchioles 

 and alveoli, and produce proliferation of round cells, which undergo 

 fatty degeneration. The resulting patches of peri-bronchitis or 

 pneumonia become yellowish-white ; suppuration and haemorrhage 

 from the capillaries follow, and small cavities result, containing pus 

 cells, fat granules, blood, and the fungi. In the neighbourhood of 

 the new growth there is compression of the alveoli, and ultimately the 

 formation of a dense stratum of connective tissue, separated from the 

 cavities by a lining of granulation tissue containing the character- 

 istic fungus. The symptoms are usually obscure ; but the sputum 

 may contain the fungi, which are often visible to the naked eye. 

 The apices of the lungs are not, as a rule, affected. There is con- 

 siderable clinical resemblance to chronic phthisis : cough, night- 

 sweats, pallor, shortness of breath, and haemoptysis are symptoms 

 common to both. Light may be thrown upon the case by the examina- 

 tion of the sputum. The presence of the actinomyces will be positive 

 evidence as to the nature of the disease. The existence of these 

 symptoms, with absence of tubercle bacilli, would lead to the 

 suspicion of actinomycosis, even failing the discovery of the fungus 

 in the sputum. 



In the second stage the symptoms are more characteristic. The 

 diseas3 spreads to neighbouring parts, and pleurisy commonly super- 

 venes. This extension may involve the peri-pleural tissues. Thus 

 the disease may follow the prse-vertebral tissues, descend behind the 

 insertion of the diaphragm, and point as an ordinary psoas or 

 lumbar abscess ; it may perforate the diaphragm and reach the 

 abdominal cavity. Peritonitis or sub-phrenitic abscess may then 

 result. In some cases adhesions have formed, and the disease has 

 extended to the liver or spleen, or other abdominal organs. The 

 disease may also extend forwards in the direction of the anterior 

 mediastinum and the pericardium. 



The primary affection of the lung becomes of secondary import- 

 ance. Grave symptoms occur, hectic fever, night-sweats, rigors, 

 and marked pallor. In the third stage, the disease comes to the 

 surface, either over the chest, or in the neighbourhood of the dorsal 



