Actinomycosis. Lumpy-Jaw. 41 



throat. Cases affecting the neck would extend to the shoulder. 

 In the chest primary formations have been found in the bron- 

 chia, cesophagus and mammae, and secondary in the mediastinum, 

 lungs, intercostal spaces and pleurae. In the abdomen, the in- 

 testine, liver, peritoneum, bladder, womb, ovaries, and 

 abdominal walls have been invaded by the parasite. 



Diagnosis. This must depend on the recognition of the 

 actinomyces in the morbid prodiict. With open sores this is not 

 difficult. In their absence the soft swellings may be aspirated to 

 secure a specimen, or the hard bony one may be incised and 

 scraped. The following should be ground for suspicion : the 

 slow progress of the disease, the comparative absence of pain or 

 tenderness, the tendency to invade all adjacent tissues indis- 

 criminately neither selecting nor rejecting any particular organ, 

 the indisposition to invade the adjacent lymph glands, more than 

 other parts, the tendency when near the surface to form ulcerous 

 sores or fistulae leading to a more or less firm granulomatous 

 tissue, the prior connection of the patient with ground infested 

 with actinomyces, or the products of such land. 



From tubercle, external forms may be distinguished by the 

 comparative immunity of lymphatic glands, and internal ones 

 by the absence of reaction to tuberculin. 



From Cancer it differs in showing no predilection for the glands, 

 in many cases by the comparative immunity of the skin, by the 

 less violent character of the pain, and by the tendency often shown 

 to advance while improvement goes on in the previous seat of the 

 disease. 



From glanders it is distinguished by the absence of any special 

 disposition to attack the lymph glands and nasal mucosa, and by 

 the absence of any reaction under mallein. 



From these and other neoplasms it is distinguished by its 

 tending to improvement under a course of potassium iodide. In 

 this it agrees with the gummata and fibroid growths of syphilis 

 in man, but in that disease there is usually a history of heredity 

 or infection, the presence of the characteristic chancre, mucous 

 patch, siphiloderm, or sore throat, the contour of the syphilitic 

 teeth or some other unequivocal symptoms. 



From pyaemia it is to be distinguished by the persistence of the 

 firm granulomatous product, the scanty production of pus around 

 it, and presence in the pus of the yellow actinomyces tufts. 



