. A practical treatise on medical diagnosis for students and physicians . he serous or sanguinoserous exudation in the pleura. The sputumat this time may accidentally contain the parasite, although this is rare;it is mucopurulent, but it is said never to contain elastic fibres. Thecourse of the disease at this time may extend over many months, in con-tradistinction to empyema on the one hand and carcinoma on the other. 810 THE INFECTIONS. In the final stage ulceration of the swelling is seen in many places,a fistula forms, and the disease extends to adjacent structures. Metastasis. Secondary i
. A practical treatise on medical diagnosis for students and physicians . he serous or sanguinoserous exudation in the pleura. The sputumat this time may accidentally contain the parasite, although this is rare;it is mucopurulent, but it is said never to contain elastic fibres. Thecourse of the disease at this time may extend over many months, in con-tradistinction to empyema on the one hand and carcinoma on the other. 810 THE INFECTIONS. In the final stage ulceration of the swelling is seen in many places,a fistula forms, and the disease extends to adjacent structures. Metastasis. Secondary infection may occur and symptoms of pysemiadevelop. The masses which form upon the intestinal mucous membranemay lead to suppuration and perforation of the intestine. Metastasis toany organ may occur, with resulting local symptoms. The durationdepends upon the organs involved in metastases. If metastases do notlead to early death, that result is brought about at the end of monthsor years by slow pysemia, with resulting amyloid degeneration and itsconsequences. Fig. Character of the Pus. Actinomycosis is usually associated with chronicinflammation and the production of pus. The pus is peculiar. It isthin and viscid. Nodules of gray or yellow color, the size of a poppy-seed, can be seen in it with the naked eye when it is spread on& slide. With a low power these particles appear as aggregations ofspherules, which with a higher power are seen to be arranged in massesradiating from a common centre. Each separate spherule is have high refractive power. The centre of the masses is occupiedby a network of fibres. If the mass be broken up, numerous club-shaped forms are seen at the periphery, while at the centre a sort ofdetritus alone is observed. The micro-organism belongs to the class offission-fungi, and the club-shaped bodies are the degenerated forms. (SeeFig. 325.) Grams method of staining brings out the threads of the network mostdistinctly. The centre is
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