ACTINOMYCOSIS. 
11 
cases the growth is quite rapid, and in a few months the dis¬ 
ease may have invaded the larger part of one-half of the 
upper or lower jaw, and give rise to severe symptoms, caused 
chiefly from disturbed mastication and pain. 
This form of the disease is accompanied by abcesses and 
fistulas, sometimes opening into the mouth, but generally 
opening externally. When the tongue is the seat of the dis¬ 
ease, there are seen to be a more or less number of promi¬ 
nences, on the dorsum most frequently, on one or both sides, 
or even over its whole surface. These look like nodules or 
tubercles, or sometimes like warty excrescences flattened on 
top, varying in size from a millet seed or pea to a bean. They 
may be single or in clusters, and the tongue somewhat enlarged, 
indurated, and more or less ulcerated in one or more places, 
or there may be cicatrices present from previous ulcerations. 
There is degeneration more or less marked, of the muscular 
tissue, which is rather pale in color, and in the peculiar yel¬ 
lowish white nodules which are seen scattered throughout 
the tissue, will be found clusters or tufts of actinomycis. The 
gums, cheeks and palate ma}^ also be involved in the disease. 
In the fauces the disease generally appears in the form of 
new sub-mucous formations, or polypi, which present the 
same features histologically as the nodules on the tongue. 
Similar tumors to those observed in the fauces are found 
in the region of the epiglottis and larynx. 
In the oesophagus, stomach and intestines, the muscular 
and sub-mucous connective tissues are the parts invaded by 
the disease, and it shows itself by the formation of nodules 
and tumors which on section are seen to contain the 
actinomyces. 
When the disease is localized in the lungs, various changes 
take place therein, but as it is generally very insidious in its 
development, and seldom occurs in a very acute form, the 
disease may have progressed to a considerable extent, and 
have produced considerable changes in the lung tissue before 
any constitutional symptoms are presented. 
In the first stages the lung tissue will be found to have 
still retained its elasticity, but is of a whiter color, and more 
firm than in health. On the cut surface, and even on some 
