Volume 1

Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne.

Date:
1906-1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    69/576 (page 51)
    scribed undor the names of scrofulous, strumous, or tuberculous abscesses or inflammations, bone tubercle, cancer of bone, cancer of tongue, scirrhus cord, scii'rhus tongue, osteosarcoma, spina ventosa, not to mention a number of less scientific but more correct descriptive terms. Clinical Features and Diagnosis.—There is no special symptom by wiiich actinomycosis can be surely recognised. It has usually a chronic course, and according to the part of the body affected the symptoms may be those of tuber- culous caries of jaws, vertebraj, or ribs, of chronic abscesses of various kinds, of empyema, sub-phrenic abscess, peritonitis, chronic phthisis, ulceration of the bowel, tumours of bone or of viscera, etc. Fever may be present or absent. The disease occasionally assumes an acute form, owing to vascular infection, and the symptoms may resemble those of pya;mia; in such cases the possibility of a mixed infection should be kept in mind. A reliable diagnosis can seldom be made before some of the abscesses have opened upon the surface of the body, or into some cavity opening externally; the characters of the discharge may then suggest the presence of the actinomyces. The discharge may be viscid, lumpy, or resemble closely laudable pus; when spread in thin layers it is seen to contain a large number of minute whitish or yellowish specks just visilile to the naked eye ; on micro- scopical examination these specks present the microscopical features described further on. Distribution of Lesions.—All the tissues, and probably all the organs of the body, are liable to the disease. Lesions have been described in the following parts : mucous membranes (alimentary, respiriitory, and genito-urinary tracts), serous membranes (pleura, peritoneum, etc.), skin, bone, muscle, lymphatic glands, lungs, heart, liver, spleen, kidney, prostate, ovary, mamma, brain, etc. The characters and the distrilmtion of the lesions depend in great part on the mode of infection. Israel recognised three of these— (1) by the mouth, (2) by the hmgs, (3) by the intestine, to which we nnist now add (4) by the skin, (5) by the genital tract. Their relative importance is well shown by the cases collected by various observers, and notably by Illich. It will be sufficient to refer here to the figures given by Leith, for they cover the cases previ- ously published by Illieh, and some thirty addi- tional ones. Cases. Per cent. Actinomycosis of head and neck 224) 55-75 ,, tongue . 161 )) ,, abdomen 93 21-60 >) „ lungs . 57 13-25 )i ,, skin 11 2-50 >i doubtful . 29 6-90 430 100-00 In addition to these, the cases reported by Zemann and Grainger Stewart and Minr in- dicate the possibility of infection through the vagina. Primary Actiiiomyco.ns of the Mmith and Pharynx.—One or more teeth are generally found in a state of caries, or there may be wounds or ulcers aflfecting the mucous mem- bi-ane of the tongue, gums, tonsils, or pharynx. These lesions are generally supposed to favour the penetration of the parasite. The most frequent result of infection through the mouth is affection of the lower jaw, but the tongue, the upper jaw, the bones of the skull, and the vcrtebrjE may also become involved ; the disease may in this way extend to the cranial cavity and to the spinal canal. Actinomycosis of Bone.—In man the tendenc}- of this disease is to produce progressive necrosis, suppuration, and periostitis. In cattle the same processes may occur, but are generally overshadowed by extensive connective tissue hyperplasia, which gives rise to the formation of large tumours resembling closely osteosar- comata. In man the lesions of the lower maxilla affect chiefly the periosteum and surrounding- tissues ; they may take the form of burrowing abscesses or of small tumours situated on the surface of the jaw or in the sub-maxillary region ; they arc often connected by fistulous channels with the root of a carious tooth. As the suppuration progresses the skin may become involved. Soltmann's case indicates one of the ways in which the vertebrte may become affected, and is also of great interest in showing the mode of infection. The patient, a boy, had swallowed an ear of wall-barley {Hordeum murinum), a spikelet of which penetrated the walls of the CKSophagus. This led to the formation of an actinomycotic abscess, which after a time ])ointed through the sixth inter- costal space, between the spine and scapula. Actinomycosis of the Tongue is of chief interest in connection with cattle, where it is known as the wooden tongue (also tubercle, chronic sarcoma, chronic interstitial glossitis, etc.). The state is characterised by the formation of actinomycotic nodules under the mucous membrane, which, after a time, becomes ulcerated over the parts affected ; a considerable increase of connective tissue in the deeper parts of the organs (interstitial myositis) gives rise to atrophy of the muscular fibres and great hard- ness of the organ. Actinomycosis of the Intestive.—The large is more frequently affected than the small in- testine. The lesions may consist of small abscesses spreading chiefly in the submucous coat. These may point towards the surface of the mucosa, discharge into the cavity of the intestine, and their contents appear in the stools. In a case recorded by Chiari the mucous membrane presented numerous raised