ACTINOMYCOSIS.
On the detection of the tumour with its characteristic granules a free incision should be made, and after the evacuation of the contents every trace of infected tissue should he excised, curetted by a firm dry swah or destroyed by the cautery, and the surrounding structures flushed by antiseptic solutions. Where the lower jaw or the hollow facial bones are involved the gouge, chisel, and saw may be brought into requisition, and after the removal of all infected osseous tissue a strong caustic, Iodine solution or Hydrogen Peroxide should be applied, the cavity being finally firmly packed with iodoform gauze so as to insure healing from the bottom.
Iodides possess a strong selective action over the fungus, and should invariably be administered at the same time for considerable periods as in tertiary syphilis, 3o-6o grs. of the sodium salt being given thrice daily. Where the fungus cannot be reached by surgical methods, this drub has often proved efficacious when given for months in the above dosage with short intermissions. The intravenous injection of Colloid Silver or Collargol in 2 per cent. solution has been advocated in pulmonary and abdominal cases. The X rays have also proved valuable in some cases,
but their use should not be depended upon except as an adjuvant to sur gical methods and iodide treatment. The iodide has been injected into the nodules in the tongue and in facial cases, and the method of cata phoresis has been employed afterwards with success, no deformity being produced.
Much can be said for the method of injecting Iodides into the tumour and afterwards exposing this to the X rays or Radium. This latter agent has been introduced into the lung tumour for 24 hours in the dose of 47 ingrrns.
Vaccine treatment has proved decidedly beneficial, beginning with a dose of half a million fragments of a stock or autogenous vaccine, the amount being cautiously increased according to the severity of the reaction up to 3o or 4o million at intervals of 4 to 8 days. Supplemental injections are required of the other organisms present in the secretions, hence the greater value of autogenous vaccines. Injections of sterilised Milk in the gluteal region have recently been advocated in doses of 5 c.c. by Dziembowski; these are followedby a smart rise of