Anatomical Changes. 653 



the tumor may perforate the skin of the face in the temporal 

 region, or the hard palate, and project into the oral cavity. 



When occurring in the pharynx, actinomycomata consist 

 of mushroom-like polypous tumors, slightly pedunculated and 

 occasionally filling the entire pharyngeal space. On the other 

 hand they may be observed as more or less prominent, irregular, 

 or lobulated tumors under the skin on either side of the throat. 

 In some instances these retropharyngeal tumors which consist 

 almost wholly of granulation tissue containing soft, grayish- 

 yellow foci, may also contain large abscesses which may per- 

 forate to the interior or to the exterior, as the case may be. 



Actinomycosis of the esophagus is very rare. Siedam- 

 grotzky & Johne observed small flat subepithelial nodules, the 

 larger nodules containing a yellowish transparent focus. The 

 confluence of the smaller nodules gave rise to larger irregular 

 groups which projected into the esophagus. In rare instances 

 large polypi may be observed, or roundish tumors with smooth 

 surface may occur on the esophageal wall near the larynx 

 (Joest). 



In exceptional eases actinomycosis has been observed in 

 the omasum (Bollinger), in the reticulum (Johne), in the 

 abomasum and small intestine (Perroncito, Jensen, Axe), occur- 

 ring either in the form of tumors resembling fibromata or 

 sarcomata, roundish in form or lobulated, and containing soft 

 foci in the interior, or in the form of morbid changes resembling 

 tuberculous ulcers. In nearly all cases adhesions had occurred 

 in the affected portions of the intestine. 



In the affection of the abdominal organs we occasionally 

 find the peritoneum covered with numerous actinomycomata 

 of various sizes, the latter also being frequently present between 

 the tough pseudo-membranes which unite the affected organs 

 and loops of intestine. These -tumors are frequently suppurat- 

 ing or ichorous. The liver often contains metastases. Wliether 

 or not actinomycosis of the peritoneum ever occurs (as is 

 assumed by Jensen) is as yet an open question. 



Actinomycosis of the respiratory organs is of much less 

 frequent occurrence. Kitt observed involvement of the nasal 

 mucous membrane in the form of grayish-white nodules as 

 large as millet seeds and containing yellow centers. Bragadio 

 observed excessive proliferation and Eoders, in one instance, 

 saw a tumor which developed near the opening of the nostrils 

 and almost completeh;^ obliterated them. Stadie and Kutsera 

 each found in one instance diffuse infiltration of the mucous 

 membrane of the nose and its sinuses, the mucous membrane 

 was firm in consistency, irregular on its surface and in some 

 places 5 mm. thick. Its substance contained numerous grayish- 

 yellow nodules. , These nodules, some of which were as large 

 as peas, were frequently confluent, forming folds and ridges 

 or more extensive prominences (Kutsera referred to this form 

 as actinomycosis confluens). Similar nodules may also occur 



