. American practice of surgery ; a complete system of the science and art of surgery . tendency to heal (see Figs. 19 and 20). Thedisease burrows deeper, setting up new^ foci; and extends superficially, formingnew sinuses. Either from the outset, or in the course of the disease, a mixed in-fection takes place, and pain and fever w^ith real abscess formation, due to theassociated pyogenic cocci, give the clinical picture of pyaemia. The most strik-ing characteristic of the slow and steady invasion of the actinomyces is its * Joum. Med. Research, Boston, 1904^05, xiii., 349. 58 AMERICAN PRACTICE
. American practice of surgery ; a complete system of the science and art of surgery . tendency to heal (see Figs. 19 and 20). Thedisease burrows deeper, setting up new^ foci; and extends superficially, formingnew sinuses. Either from the outset, or in the course of the disease, a mixed in-fection takes place, and pain and fever w^ith real abscess formation, due to theassociated pyogenic cocci, give the clinical picture of pyaemia. The most strik-ing characteristic of the slow and steady invasion of the actinomyces is its * Joum. Med. Research, Boston, 1904^05, xiii., 349. 58 AMERICAN PRACTICE OF SURGERY. spread without any regard to the hmits of organs or of the histological tissue inwhich it starts. It is not carried along the course of the lymphatic vessels andnodes. The disease process extends, that is to say, not by continuity, but hycontiguity. Starting in the soft parts, it will attack che bone. Starting in thebase of a lung, instead of spreading throughout the pulmonary lobe, it maytraverse the pleura, setting up a limited pleuritic abscess, attack the ribs and. Fig. 19.—Actinomycosis. {After Neumann.) sternum or perforate the chest wall, pierce the diaphragm, infiltrate the omen-tum, and, as in a case reported by Murphy,* float the spleen in a large, sub-diaphragmatic abscess. In other cases the infection has burrowed its way alongthe spine, and has set up perityphlitic abscess, or psoas abscess, or has riddledthe abdominal parietes with perforations. Metastasis occurs and the liver is notuncommonly infiltrated with the fungus. 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 di
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectsurgery, bookyear1906
