To Illustrate the Article by Dr. Vander Veer and Dr. Elting, on a of the subject of Actinomycosis, with Report of a Case

of Actinomycosis Abdominalis."

Albany Medical Annals, January, 1902.

"Resume

opinion as to the exact botanical classification of the actinomyces, resulting largely from the marked pleomorphism manifested by the microorganism, as well as its capacity for the infection of a great variety of animals. The above fact is evidenced by the great variety of names that have been proposed for the fungus as Bacterium Actinocladothrix by Affanasjeff, Nocardia Actinomyces by Terni and Trevisan, Streptothrix Actinomyces by Doria, Nocardia Bovis by Blanchard. The true distinction between actinomycosis, Madura foot, and the group of pseudo-actinomycoses, was first clearly established by Blanchard in 1895.

In the infected tissue, the contents of abscess cavities or the discharge from fistulous passages, one usually finds the actinomyces present in the form of small, yellowish, more or less opaque granules, varying in size from .15 to 75 mm., although larger granules often occur. In their earliest stage the granules are usually grayish white, transparent, and are easily broken up, the consistency being that of a soft jelly. As the granule grows older it tends to become more opaque and more yellow and finally it may become impregnated with calcium salts giving rise to a structureless concretion. This gradual transformation of the granule is the result of the metamorphosis of its constituent elements. In the early stages the granules are composed of homogeneous fine threads which later on become thicker and at their ends present bulbous swellings. Gradually the threads assume a more and more compact and intricate arrangement and the bulbous swellings are arranged radially about the periphery of the granule. The mycelium usually appears as a bacillus from 3-6μ in length, arranged in threads with numerous branches. These threads frequently stain very irregularly and often present somewhat of a streptococcus appearance. Böstrom and most observers regard these coccus forms as spores. The bulbous swellings often seen about the periphery of the granules are now regarded as a product of degeneration of the mycelium.

The actinomyces stain readily with the ordinary basic aniline dyes and are not decolorized by Gram's method, while the bulbous swellings, already referred to, stain only with acid dyes. This change in the staining properties of the

bulbs is evidently the result of the degenerative process through which they are developed,

The actinomyces is a facultative anaerobe and grows upon most of the ordinary bacteriological media. The most favorable temperature is from 33° to 37°C., and even under these conditions development of the cultures is usually slow, requiring from five to fifteen days. Very often the actinomyces are mixed with some other microorganism, the growth of which is more vigorous, and tends to obscure the actinomyces. The microorganisms most commonly found in association with the actinomyces, have been the staphylococci, the streptococci, the colon bacillus, and the leptothrix buccalis. There also appears to be an antagonism between the actinomyces and the associated microorganisms as a result of which the virulence of the actinomyces is often rapidly attenuated. The actinomyces also possesses a surprising ability to develop upon cereals, as well as upon vegetable media in general. The growth of the fungus is arrested by a temperature of 45°C. and at 60°C. it is rapidly destroyed. The spores are more resistant to injurious agencies than is the mycelium although less so than the spores of bacteria.

An interesting fact is the greater resistance to noxious agencies possessed by the spores, when grown upon cereals. Experiments by Berard and Nicolas have shown that the spores have lived as long as four years upon certain cereals and under unfavorable conditions.

The actinomyces does not appear to produce any active toxine in the cultures.

Positive results following inoculation experiments have been somewhat uncertain, both with the cultures as well as with the direct products of the lesion. In the majority of instances these experiments have been failures, although Ponfick, Hanau, Wolff, Israel, Johne and Böstrom have reported positive results. There are a few cases on record in which it seems probable that man has contracted the disease from animals, but it would appear that prolonged, intimate and close contact is necessary to produce an infection. All this seems to indicate that the virulence and infectiousness of the actinomyces are diminished in the animal organism.

The consensus of opinion is that the great carriers of the actinomycotic contagion are the different forms of cereals, especially barley, and it is mainly through their agency that man and the domestic animals become infected. In certain cases pieces of cereal grains have been found in the focus of infection and the history of the case has been such as to point almost definitely to their being the source of infection. Vegetables, especially those grown above the ground, may also convey the contagion to both man and animals.

Men are much more frequently affected than women, probably as a result of their being more exposed to infection. Of 357 cases of human actinomycosis cellected by Hutyra one-third occurred in the third decade.

Five chief avenues of infection have been distinguished: (1.) through the mouth and pharynx; (2.) through the respiratory tract; (3.) through the gastro-intestinal tract; (4.) through the skin, wounds, etc., and

(5.) a group of cases, in which no definite portal of entry is discoverable.

The debut of an actinomycotic lesion is accompanied by a more or less marked phagocytosis, the cells being of both an epithelioid and a leucocytic character. Should the protective activity of these cells gain the upper hand the lesion will be a slight and insignificant one. The process, however, usually extends and the degeneration of the tissue, together with the accumulation of leucocytes, may give rise to a seropurulent focus and this without the intervention of any secondary infection. This product of necrobiosis is, however, to be distinguished from pus in the stricter sense of the word. Microscopically a focus of actinomycotic infection is characterized by a central zone containing the fungus either free or attached to the foreign body by means of which it gained access to the part. In this zone there is more or less cellular detritus and products of degeneration. Next comes a zone characterized by the presence of round cells and epithelioid cells, the degeneration of which supplies the detritus already alluded to. The outermost zone of the actinomycotic focus is characterized by a more or less extensive area of granulation tissue. As in any chronic inflammatory process