. American practice of surgery ; a complete system of the science and art of surgery . us. Symptoms.—The varied gross pathology of actmomycosis gives rise toequally varied symptoms, which are more marked in mixed than in simple infec- * North Am. Pract., Chicago, 1891, iii., 593. ACTINOMYCOSIS. 59 tion, and more serious the deeper and more numerous and extensive the foci ofthe disease. Ruhriih has collected over a thousand reported cases in man, andfinds that the head and neck are affected in fifty-six per cent, the digestive tractin twenty per cent, the lungs in fifteen per cent, and the skin
. American practice of surgery ; a complete system of the science and art of surgery . us. Symptoms.—The varied gross pathology of actmomycosis gives rise toequally varied symptoms, which are more marked in mixed than in simple infec- * North Am. Pract., Chicago, 1891, iii., 593. ACTINOMYCOSIS. 59 tion, and more serious the deeper and more numerous and extensive the foci ofthe disease. Ruhriih has collected over a thousand reported cases in man, andfinds that the head and neck are affected in fifty-six per cent, the digestive tractin twenty per cent, the lungs in fifteen per cent, and the skin in two per cent. Diagnosis.—Chiefly because of the mixed infection and abscess formationusually encountered in actinomycosis, it is often mistaken for an ordinary -pijce-mia, its true nature being overlooked. The surgeon should have actinomycosisin mind hi the presence of lesions for whicli it woxM account. Usually the char-acteristic bright yellow granules will not be seen in the discharge as it weepsfrom the sinuses, but on manipulation and firm digital pressure some of them. Fig. 20.—Actinomycosis Abdominalis. {Vander Veer and Elting.) will be squeezed out in the pus. They are the more readily seen if the pus bespread on a piece of glass. The disease has frequently been mistaken for sar-coma, especially in cases w^here the bone is involved. In sarcoma, however,suppuration occurs later, if it occurs at all. The diagnosis of actinomycosismust always rest directly and finally on the demonstration of the fungus. Inpulmonary actinomycosis the symptoms are the same as in tuberculosis, but bycareful search the yellow granules can be detected in the sputum, and the prac-tised eye will recognize the fungus in the fresh state under a low power. For asatisfactory demonstration characteristic granules should be crushed betweentwo cover glasses, spread, dried, fixed by passing through the flame, and stainedby Grams method and orange rubin. The granules may be embedded in par-affin
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