122 
GEORGE FLEMING. 
in the occipital lobe of the right cerebral hemisphere. In this 
remarkable case, the fungus-bodies were found in the sinuses of 
the neck, in the substance of the sarcoma-like growth of the 
jugular vein, in the tumor of the right auricle and ventricle, and 
elsewhere. In the fourth case, the illness began fourteen months 
before death, following the extraction of an upper molar tooth ; 
it consisted of swelling in the region of the right maxillary joint, 
tumefaction of the face, and subsequently of the neck; succes¬ 
sive outbreaks of abscesses and sinuses in these regions. Death 
occurred from extreme exhaustion. The yellow fungus bodies 
were frequently obtained in this case from the sinuses during 
life. The record of the case is too elaborate to be given, even iii 
outline, but it may be mentioned that there was, besides the ex¬ 
tensive sinuses and granulation-centres of the face and neck, a 
pnevertebral abscess extending from the basilar process of the 
occiput to the fourth dorsal vertebra, with osteophytic growths 
from all the bones, together with caries of both occipito-atlantal 
joints and of the right atlanto-axial. In the fifth case—a boy— 
the first indication of illness was a year before death, when he 
had symptoms of pleurisy ; nine months later, there was a new 
and much more severe affection of the same side, with general 
dropsy, progressive swelling in the lower part of the back, and 
evacuation of pus from a cavity opposite the eleventh left rib. 
Post mortem , a large prsevertebral cavity was found on the left 
side, partly retropleural at the level of the eighth, ninth, and 
tenth ribs, and partly retroperitoneal at the level of the last two 
ribs and the left kidney; also several perforations of the 
diaphragm. There were numerous centres of Actinomykosis in 
the muscles of the back, in the intercostals, and in the left psoas 
muscle; also in the muscular substance of the left ventricle, and 
in the upper end of the spleen. 
In RosenbachVcases, the disease commenced in the neighbor¬ 
hood of the jaws, and appeared to be in some way dependent 
upon carious teeth, involving the dental alveoli. Tonfick and 
Israel had remarked on this tendency of the disease to originate 
in the teeth or their sockets. This local affection is not unfre- 
quently followed 'by metastatic abscess in the liver, spleen, intes- 
