the discharge ceases and the fistulae slowly close, leaving, finally, nothing but irregular areas of pigmented scars. The duration of the disease is quite variable from a few weeks to several years. The prognosis in cases of abdominal actinomycosis even though the process may be an extensive one is not necessarily hopeless for there are on record a considerable number of cases that have recovered. In general one can say that those cases offer the best prognosis which are most amenable to surgical treatment, and it is for this reason that the prognosis is more favorable in the abdominal form than in the thoracic. The tendency to recurrence must, however, be borne in mind and this appears to be of more frequent occurrence than in the other forms of actinomycosis. The oldest cases are the most unfavorable because of the possibilities offered by them for extension or metastasis. In seventy-seven cases of abdominal actinomycosis treated surgically Grill found twenty-two recoveries, ten improvements and forty-five deaths. It is practically impossible to recognize the abdominal form of actinomycosis in its earliest stage, although the examination of the fecal matter has, in a few instances, led to a comparatively early diagnosis. In the later stages, when tumefaction is extensive, with foci of suppuration and numerous fistulae, the discharge from which contains the characteristic granules, the diagnosis is comparatively easy. In the right iliac fossa it most closely resembles appendicitis, although there is less pain, less febrile disturbance and more of a tendency to extension of the process than is ordinarily seen in subacute or chronic appendicitis. Sarcoma, carcinoma and tuberculosis of the caecal region must also be considered in differential diagnosis. The question of prophylaxis is an unsatisfactory one because of the difficulty of preventing the ingress of the actinomyces into the body. Vegetable contagion being, in all probability, the great source of human actinomycosis, greater care in the selection and preparation of cereals and vegetables would certainly diminish the number of infections by this avenue. Since thorough cooking destroys the spores of the actinomyces in flesh, prevention of infection from this source would appear to be comparatively easy. Therapeutically a so-called specific for actinomycosis has never been discovered. There exists in certain quarters an idea that potassium iodide possesses certain of the qualities of a specific in this infection. This has resulted chiefly from the work of certain veterinarians and particularly the work of Thomassen of Utrecht who, in 1885, expressed such a sentiment as the result of the favorable action of the iodide in certain cases of actinomycotic glossitis. Certain it is that a considerable percentage of the cases in human beings have been benefitted by a prolonged course of iodide of potassium and some of them definitely cured. It is necessary to administer the iodide in large doses beginning with half a drachm and gradually increasing until from two to four drachms are taken in twenty-four hours. Rydgier recommends the injection of a one per cent. solution of potassium iodide into the tissues involved. Poncet and Berard express the belief that in the treatment of the majority of cases of visceral actinomycosis, potassium iodide is not of great value, especially in the later stages when secondary infection has occurred. In general, potassium iodide appears to act more satisfactorily and effectually the earlier in the course of the disease it is administered. Experiments have shown that the iodide has little or no effect upon the growth of the actinomyces on artificial media. Various observers have tried the effect of tuberculin upon the actinomycotic process and in a few instances reported by Billroth, Kahler and others, improvement seems to have followed its use. An interesting and important fact brought out by Kahler, Illich and Wolff, and confirmed by Arloing, is that men and animals infected with actinomycosis react to Koch's tuberculin just as men and animals with tuberculosis do. Ziegler has reported a favorable result in a case of actinomycosis following the injection of the protein obtained from cultures of the staphylococcus pyogenes aureus. Gautier has seen favorable results follow the use of electrolysis, and Braun recommends highly the use of Fowler's solution and other preparations of arsenic. In general, however, combined medical and surgical treatment would appear to have pro duced the best results and especially is this true in the forms of actinomycosis more superficially placed. The surgical treatment of all cases amenable to operation should be practised combined with large doses of potassium iodide. In the abdominal and visceral lesions it is frequently difficult to determine the extent of the process and consequently the extent of the surgical intervention required. Careful exploration of the fistulae and foci should be practiced, so far as possible, with the removal of as much of the diseased tissues as possible. If apparent recovery should occur the case should, nevertheless, be watched for several years because of the great possibility of recurrence. M. A. S., Castleton, N. Y., aet. 45; native of U. S.; occupation, carpenter; married. Admitted to Albany Hospital February 22, 1901. Diagnosis, Actinomycosis abdominalis, with inplantation actinomycotic abscess at angle of eye. Treatment, operation and medical. Family history: Father died of typhoid fever, aet. 74; mother, aet. 98; one sister of enlargement of liver; five brothers and three sisters alive and well. Had Previous history: Patient had usual diseases of childhood. typhoid fever at fifteen and was quite ill, but recovered completely. No history of any other diseases. Denies venereal disease of any kind. Has drank but little of stimulants. Smokes and chews tobacco rather excessively. Has not been associated much with animals; never worked in grain. General health has always been good. No cough, shortness of breath, bowel or bladder trouble. Never had any serious injuries. Present illness began November 27, 1900, previous to which time patient had been perfectly well. Trouble began with pain in stomach, while at work, but finished day's duty and then took various remedies without relief. Had sharp cramps, chiefly in lower part of abdomen, very severe, lasting from three to five minutes, and recurring at first every half hour or so. Physician sent for next morning, but patient did not obtain relief from pain for a week. Pain then gradually diminished, but eight weeks elapsed before it entirely disappeared. No chill, fever or vomiting; slight nausea. Pain did not tend to become localized nor to radiate. Seemed to patient it was in bowels. No jaundice. Abdomen never distended, so far as patient knows. Bowels moved regularly; urination was normal. About the first of January, 1901, he was able to be up and around and improved quite rapidly. About the middle of January he went to work superintending an ice gang. Improvement continued, and by February 1st the patient stated he was as well as ever, having regained all the flesh he had lost. February 20th, while still feeling perfectly well, the patient To Illustrate the Article by Dr. Vander Veer and Dr. Elting, on a "Resume of the Subject of Actinomycosis with Report of a Case |