ACTINOMYCOSIS 227 



swelling, which gradually enlarges, softens, and inclines to 

 approach the surface, when fluctuation is sometimes to 

 be felt. The skin becomes bluish-red, as over a chronic 

 abscess, and eventually a small yellow point forms, and 

 a yellow serous or pus-like fluid escapes ; and in this dis- 

 charge the yellow granules will be visible. If a little of 

 this fluid be allowed to run gently down the side of a test- 

 tube, which is then held up to the light, the small yellow 

 grains will be visible, which may be picked out, placed 

 on a slide, and pressed down with a cover-glass. It will 

 transmit to the finger a sensation similar to that of 

 squeezing a drop of solid fat, if the granule was taken 

 from man ; while if from an animal, the granule is more 

 gritty, from calcareous degeneration. On examining the 

 slide with a low power, a number of ovoid, kidney-shaped 

 masses are seen, which with a higher power show the 

 characteristic club-shaped structure. The periphery of the 

 swelling always feels hard, and a chronic fistulous opening 

 into the cavity may persist for months. The general 

 tendency of the disease is to spread continuously, the older 

 portions of the cavity sometimes showing a tendency to 

 form scar tissue, as in animals. There is rarely any pain, 

 fever, or constitutional symptoms. 



Bostrom considers the softening process an index to the 

 life and activity of the organism, and says that when a 

 centre is formed by granulation, the fungus is either 

 inactive or dead. 



The club forms are regarded by Bostrom as degeneration 

 forms of the terminal filaments of the fungus. Crookshank 

 says that each filament is enclosed in a sheath, and it is 

 owing to this undergoing mucilaginous degeneration that 

 the club forms are produced ; and if a little water is run 

 under the cover-glass, the [club form disappears, leaving 

 the mycelium exposed to view. The active fungus appears 



