ACTINOMYCOSIS 265 
In the skin and subcutaneous tissue. The lesions of the skin and 
subcutis are found chiefly on the head and neck. They usually con- 
sist of firm nodules from the size of a hazel nut to that of a man’s fist 
or even larger. Sometimes these nodules are pedunculated and at 
others they are attached to the skin by a broad base. Instead of the 
hard tumor there may occur soft granular fungoid proliferations 
Fic. 61. ORDINARY FORM OF SINGLE ACTINOMYCOTIC NODULE IN THE TONGUE. (a) 
ACTINOMYCES; (b) CENTRAL ZONE; (¢c) MIDDLE OR INTERMEDIATE ZONE; AND (d) 
PERIPHERY OR OUTER ZONE OF THE NODULE. (AFTER JOEST). 
covered with a brown crust or with a purulent secretion. At other 
times minute nodules appear in these proliferations and the skin 
becomes thickened and indurated. However, the skin lesions may 
become very large. In this organ, the disease may be either primary 
or secondary. : 
In the lymph glands. Actinomycosis often appears in the lymph 
glands of the head, larynx and pharynx. The parotid and sub- 
maxillary glands are sometimes involved as secondary infections. It 
is reported that the sub-parotid glands are most frequently affected. 
