72 CLINICAL BACTERIOLOGY AND HEMATOLOGY 



The importance of making this examination as a routine method 

 in all cases in which the diagnosis is not absolutely clear must be . 

 strongly urged on all practitioners, since an accurate diagnosis of 

 actinomycosis rnay be followed in many cases by a cure by means 

 of large doses of iodide of potassium. Actinomycosis has a habit 

 of turning up when least expected; thus, I have found it accident- 

 ally in three cases in the sputum where the true diagnosis was 

 not suspected ; once in an enlarged tonsil ; once in an apparently 

 typical case of cancer of the breast, etc. 



The films should be carefully examined for the presence of 

 these structures. Clubs are not likely to be found in the pus, 

 and their absence does not tell against the diagnosis ; the dense 

 felted network of filaments retaining Gram's stain is what is to 

 be looked for, and its presence is quite sufficient for a diagnosis. 

 Fortunate specimens may show a complete colony, with its 

 irregular network in the centre and the radial arrangement of 

 the fibres on the periphery, or there may be mere fragments of 

 mycelium. 



A few cases of actinomycosis have been treated successfully by 

 means of vaccines by Dr. Wynn, of Birmingham, and this method 

 should always be remembered when dealing with cases which 

 resist the more, ordinary treatment by large doses of iodides. 



GLANDERS 



Glanders is one of the infective granulomata, and is closely 

 allied to tuberculosis ; it differs, however, in running a more rapid 

 course and in the greater tendency which the specific lesions 

 exhibit to undergo suppuration. It is caused by the B. mallei, 

 an organism which is nearly as long as the tubercle bacillus, and 

 decidedly thicker. It stains readily with all stains, and is easily 

 decolorized ; it loses its stain when treated by Gram's method, 

 and does not form spores. 



The bacteriological diagnosis of the disease is not easy, and 

 should be referred to a bacteriologist. A quantity of the discharge 

 from a suspected case should be taken with aseptic precautions 

 and transmitted as soon as possible in a test-tube or bottle which 

 has been sterilized by dry heat or by boiling. Pus had better be 

 sent in a pipette. 



Where abscesses are opened, cultures taken direct from the pus 



