LUPUS. — The diagnosis depends, in this condition, upon microscopical ex amination.
Etiology.—Both men and animals are probably infected from vegetables or water (Israel), from eating ears of bar ley, or rye, when the fungus penetrates through the wound or abrasion thus pro voked, or in many cases through carious teeth. Intestinal actinomycosis is due to taking contaminated food or water, when the fungus becomes implanted upon an already diseased tissue, multiplies, and causes active proliferation of the submu cous tissue.
Case where the affection was trans mitted by kissing, between bridegroom and bride. Baracz (Wiener med. Presse, Jan. 6, 'S9).
[Farmers should be warned against the habit, so common among them, of chewing bits of straw, wheat, oat-chaff, etc., the most prolific cause of the dis ease. E. LAPLACE.] Actinomycosis is frequently met with in shoe-makers. This is due to their habit of placing their needles in their mouths. Ullmann (Le Bull. MM., Nov. IT, '97).
Actinomycosis of the lower jaw ac (plied by a toothbrush maker in the following manner: Hogs' bristles were washed, then held in mouth before stick ing into the handle-holes in bundles. Guinard (Bull. et Mem. de la Soc. de Chir. de Paris, T. 26, No. 6, 1900).
Total of 72 cases of actinomyeosis from American sources collected. Six personal cases, 2 of which had not been previously reported. In one alveolar ab scess followed chewing wheat-grains with a carious tooth. In a second case a quantity of pus collected in the right iliac fossa. The patient died of malnu trition, having recurred after evacua tion. J. Riihra (Annals of Surg., Feb., 1900).
Pathology. — The actinomycoses were formerly thought to be mold-fungi (hyphomycetes), but Bostroem, in 1385, proved by cultivating them that they were a variety of cladothrix, belonging to the schizomycetes.
The mass is made up of granulation tissue, which, except for the presence of the ray-fungus, would be mistaken for a round-celled sarcoma. Epithelioid ele ments and giant cells are also seen. In the granular mass, or in the pus coming from a case of actinomycosis, the fungus itself appears under the form of small, yellow, brown, or even green masses, about a pin-head in size, which, on microscopical examination, are found to be composed of a central interwoven mass of threads, from which radiate club-shape-ended rays; in some speci mens certain rays project far beyond the others. In man the clubbed bodies are
frequently absent (Senn). The histo logical lesions are alike in the actino mvcotic nodule and in the tuberculous follicle; only .the foreign body differs. Water or a weak solution of sodium chloride causes the rays to swell enor mously and lose their shape; ether and chloroform have no action upon them.
The yellow grains are not always to be found in &tulle, etc., unless they are carefully sought in scrapings, etc. An early diagnosis is essential, since later the disease may be beyond the resources of therapy. A. Poncet and L. Berard (Le Bull. MM., Mar. 28, 1900).
Case in which microscopically there was no appearance of the ray-fungus in the fresh pus, and yet microscopical examination showed the presence of fun gus at once. The absence of the typical grouping of the micro-organisms is not sufficient to exclude the diagnosis of actinomycosis, as the micro-organisms tend to arrange themselves in different ways at different times. W. Silber schmidt (Deutsche med. Woch., Nov. 21. 1901).
At a certain stage there are in every colony three elements,—viz.:— 1. Club-shaped formations.
2. A centrally-placed net-work of fun gous filaments of varying shape and size.
3. Fine coccus-like bodies (spores), which originate from the fungous fila ments, and grow into long rods and branching twigs.
Typical aetinomycosis is the disease in which occur the characteristic mycelia] masses, having club-shaped radiations. Atypical actinomycosis includes such diseases as Nocard's farcin de horn!, and infections which clinically and anatomic ally resemble actinomycosis, and are caused by branching mycelia] organisms which correspond quite closely to the cultural peculiarities of the streptothrix actinomyces, but fail to form the char acteristic grains in the tissues and pus. Berestneff (Zeit. f. Hyg. u. Infekt., vol. xxix, p. 94, '98).