purulent inflammations generally pursuing a chronic course, and exhibiting the peculiarity that hard granules appear in the pus secreted, and these are found on microscopic examination to contain ray-fungi. The latter exhibit in part slender filaments, in part bulbous enlargements (Fig. 85). Often chronic inflammation of the lower jaw, less commonly of the vertebral column, of other bones or of the skin, is present. Actinomycosis of the bronchi is attended with symptoms of putrid bronchitis, and similar disease of the lungs with infiltration and the formation of cavities, so that the possibility of chronic pulmonary tuberculosis is suggested. In both instances the demonstration of actinomycesgranules in the sputum would be of diagnostic significance. Often symptoms of pleuritis, peripleuritis, and mediastinitis are super

FIG. 85.-Actinomyces-granule from a disease focus in the lunz Weigert an oil-immersion; magnited 10 times persona. 'servation. Z

added. Intestinal actinomycosis is occasionally attended with the symptoms of perityphy liti-. At times actinomyces-nodules are .present in the brain, and during lite thes are attended with symptoms of cerebral tumor. The disease or promoted over many years, new inflammatory and purent tiggearing on stantly, and it frequent resembles grosprites A pestive diagnosis of actinomycosis is possible ons logic methods.

The prognosis of getin mycos

ally bad.

Treatment.-Emal actin

number of instances

edies, potassium iodid

1.

T....

)

our in a

operative measures

FOOT-AND-MOUTH DISEASE (EPIZOOTIC
APHTHAE).

Etiology.-Foot-and-mouth disease occurs especially in cattle, and is acquired by human beings principally through the ingestion of unboiled or insufficiently boiled milk or milk-products (butter, cheese) from diseased animals. Milkers are occasionally infected from the entrance into wounds upon the fingers or hands, in the act of milking, of the contents of vesicles that often develop upon the udders of cows suffering from foot-and-mouth disease. The infective agent is unknown, but, in any event, it is contained, in addition to the milk, also in the blood, the saliva, the urine, and the feces.

Symptoms. The period of incubation is generally three or four days. At the end of this time fever sets in and the temperature at times reaches the level of 40° C. (104° F.). Some two days later vesicles form upon the mucous membrane of the lips and tongue; less commonly upon the mucous membrane of the hard and the soft palate. In addition, vesicles appear around the nails and between the toes and the fingers, occasionally also upon the breasts. Sometimes a roseolous and erythematous exanthem appears in places. The patients complain of burning and pain in the mouth, while the discharge of saliva is increased, and occasionally they present marked gastro-enteritic symptoms, which may become dangerous especially in children, although death occurs but rarely. In the second week of the disease the cutaneous vesicles dry up into thin crusts, which soon fall off without leaving cicatrices. The disease terminates in the course of three or four weeks.

The diagnosis depends essentially upon a knowledge of the possibility of infection.

Treatment. As a prophylactic measure the use of unboiled milk from diseased animals should be forbidden, as well as that of milk-products. Boiled milk also is rendered harmless only by longcontinued boiling. Milkers should engage in their pursuit only if. their hands and fingers are free from injury. When the disease has developed the mouth and the pharynx should be rinsed after each meal with potassium chlorate (5.0: 200). Vesicles upon the skin should be covered with absorbent cotton smeared with a borated ointment. In the presence of gastro-enteritic symptoms potassium chlorate should be administered internally (5.0: 200— 75 grains:63 fluidounces-from 5 to 15 c.c.-from 1 to 4 fluidrams -every two hours after food.

RABIES (LYSSA; HYDROPHOBIA).

Etiology.-Human beings are generally attacked by rabies in consequence of the bite of rabid dogs, less commonly of other rabid animals, as, for instance, cats, horses, cows, wolves, foxes. Other modes of infection are rare, although a few years ago a pathologic anatomist at Prague became inoculated in the postmortem examination of a dog dead from rabies, dying likewise from rabies.

The infective agent is as yet unknown, although it has been determined that it is contained in the blood and the saliva of diseased animals. Not every bite of a rabid animal is followed by rabies in man; particularly in the case of bites through the clothing the saliva of the rabid animal is often intercepted. Bites on the face, upon the hands, and upon the uncovered legs and feet, on the other hand, are especially dangerous.

Symptoms. The period of incubation of rabies exhibits great variations. Generally it is from fifteen to eighty days, but occasionally it extends over six months. Reports as to periods covering several years (up to thirty) are probably beyond the limits of credulity. Pains and increased discharge from the wound are mentioned as prodromes, and if cicatrization has already taken place, reopening of the scar. The patient becomes pallid and restless and harassed by a fear of the terrible disease. The distinctive symptoms consist in attacks of muscular spasm, which at first involve the muscles of inspiration, and as a result cause irregular, deep, and sighing inspirations, in consequence of which respiration is greatly interfered with. The patient at the same time becomes cyanotic. Soon spasm in deglutition appears, which at first is manifested only on attempts at swallowing, but subsequently sets in as soon as food and drink are brought into view, and even upon the thought of them, thus rendering the ingestion of food impossible. Such spasms occur also at the sight of water, and the disease has, therefore, been designated hydrophobia. From time to time, subsequently, attacks occur, attended with delirium, snapping movements of the jaws, and also general convulsions. These attacks follow one another with gradually increasing frequency, lasting longer and longer, and frequently causing death amid progressive exhaustion, at the latest at the end of the second week of the disease.

Diagnosis. The diagnosis of rabies is generally easy, particularly if the history renders certain antecedent infection. In doubtful cases portions of the medulla oblongata of those dead of the disease may be injected beneath the dura in rabbits, and the development of morbid symptoms in the animals awaited.

Prognosis. The prognosis was formerly serious, but since

the discovery of curative inoculation by Pasteur most patients are saved.

Anatomic Alterations.-Anatomic alterations distinctive of rabies are not known. Hemorrhages into the meninges and into the substance of the brain and the spinal cord have been described as secondary conditions. On microscopic examination round-cell accumulation, swelling and vacuolation in the ganglion-cells, and swelling of nerve-fibers have been observed in the central nervous system.

Treatment.-A high license for dogs, the constant wearing of muzzles, and the leading of dogs with a chain may be recommended as prophylactic measures for the prevention of rabies in dogs. Bite-wounds should at once be sucked and be cauterized with the hot iron or with potassium hydroxid. The patient should besides be sent as speedily as possible to an institution for the practice of inoculation against rabies, such as has been erected in Paris, St. Petersburg, Vienna, and Berlin, in order to be subjected to curative inoculations according to the method of Pasteur. If rabies has developed in an individual, chloral hydrate (5.0-75 grains) should be administered and inhalations of chloroform practised if muscular spasm appears.