740 Actinomycosis 



Cases of actinomycosis are fortunately somewhat rare in human 

 medicine, and do not always occur in those brought in contact with 

 the lower animals. The fungi may enter the organism through 

 the mouth and pharynx, through the respiratory tract, through the 

 digestive tract, or through wounds. 



The invasion has been known to take place at the roots of carious 

 teeth, and is more liable to occur in the lower than in the upper 

 jaw. Israel reported a case in which the primary lesion seemed to 

 occur external to the bone of the lower jaw, as a tumor about the 

 size of a cherry, with an external opening. Two cases of the dis- 

 ease observed by Murphy, of Chicago, began with toothache and 

 swelling of the jaw. A few cases of dermal infection are recorded. 

 Elsching* has seen a case in which calcified actinomyces grains were 

 observed in the tear duct. 



When inhaled, the organisms enter the deeper portions of the 

 lung and cause a suppurative broncho-pneumonia with adhesive 

 inflammation of the contiguous pleura. After the formation of the 

 pleuritic adhesions the disease may penetrate the newly formed 

 tissue, extend to the chest- wall, and ultimately form external sinuses ; 

 or, it may penetrate the diaphragm and invade the abdominal organs, 

 causing interesting and characteristic lesions in the liver and other 

 large viscera. 



Lesions. — The degree of chemotactic influence exerted by the 

 organism seems to depend upon the tissue affected, upon the pecu- 

 liarity of the animal, and upon the virulence of the organism. When 

 an animal is but slightly susceptible, and especially when the tongue 

 is affected, the disease is characterized by the formation of cicatricial 

 tissue — "wooden tongue." If, on the other hand, the animal be 

 highly susceptible and the jaw-bone affected, suppuration, with the 

 formation of abscesses, osteoporotic cavities, and sinuses, are apt 

 to be noticed. • This form of the disease is called "lumpy jaw" in 

 cattle. 



Before the nature of the affection was understood it was con- 

 founded with diseases of the bones, especially osteosarcoma. 



From the tissues primarily affected the disease spreads to the 

 lymphatic glands, and eventually to the lungs. Israel has pointed 

 out that certain cases of human actinomycosis begin in the peribron- 

 chial tissues, probably from inhalation of the fungi. 



Butfewcasesrecover, the disease terminating in death from ex- 

 haustion or from compUcating pneumonia or other organic lesions. 



* "Centralbl. f. Bakt. u. Parasitenk.," xviii, p. 7. 



