ACTINOMYCOSIS— LUMPY JAW 455 



(so-called "wooden tongue"). In the second case throughout 

 the tongue, especially along the dorsum, nodules from the 

 size of a shoebutton to a hickory nut are felt. Occasionally 

 ulceration appears and usually just in front of the dorsal 

 prominence of the tongue. Surrounding the ulcer cavity 

 polypoid growths are often noted. The ulcer may be covered 

 with accumulations of food, hairs, etc., and obsciu-ed from 

 view. 



(c) Actinomycosis of the lips, while common in some 

 parts of Europe, is rare in this country. As with the tongue 

 there occurs a proliferation of the connective tissue especially 

 of the upper lip which becomes firm and rigid and greatly 

 increased in size. In other cases multiple nodules from the 

 size of a pea to a walnut appear in the connective tissue 

 of the lip. 



(d) Actinomycosis of the pharynx leads to severe dyspnea, 

 dysphagia and swelling in the parotid region, which in 

 some cases is quite marked. The pharyngeal enlargement 

 may be palpated from without (head extended) or through 

 the mouth. In calves firm growths the size of a fist may be 

 palpated in the thyroid region. They produce dysphagia, 

 dyspnea with wheezy respirations, and general unthriftiness; 

 marked rales may be heard on auscultation over the throat. 



Diagnosis. — The diagnosis of actinomycosis depends upon 

 finding the ray fungus under the microscope. The lesions 

 described are suggestive. Swellings due to injury might be 

 confused with actinomy comas. However, these appear 

 suddenly, show an inflammatory character and a benign 

 course. Occasionally foreign bodies (bones, shoe soles) may 

 lodge between the teeth and the cheeks, causing a protrusion 

 of the latter which resembles slightly an actinomycoma. 

 Actinomycosis of the larynx or pharynx might be easily 

 confused with tuberculosis. However, the affection of the 

 corresponding lymph glands, which occurs in the latter and 

 rarely, if ever, in the former and the use of the tuberculin 

 test, should suffice for differentiation. 



Course and Prognosis. — The course in actinomycosis is 

 chronic, the disease gradually progressing from month to 

 month until it terminates fatally. A few cases which are 



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