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THE STOMACH Whenever the Actinomyces bovis is a resident in the mouth, portions of the fungus must from time to time be swallowed, and, escaping through an abrasion of the F I G . 16. Actinomycosis of duodenum. ) gastric mucosa, may develop in the wall of the stomach ; several instances have been recorded in which the resulting inflammatory mass was so firm and fibrous that the condition was regarded by the surgeon as malignant, and the true nature was only discovered after a careful microscopic examination had been carried out.
The specimen was removed from a healthy farmer aged forty-five. Three weeks' history of roughness on the right side of the tongue, painful for one week. Teeth sound. Lesion the size of a shilling resembling a chronic carbuncle. Treated by excision of the area. Grampositive actinomycotic fungus identified in the section. ) [To face page 27. ACTINOMYCOSIS OF THE TONGUE 27 poral fossa and the spheno-maxillary fissure into the orbit. Most of the inflammatory material then forms behind the eyeball so that the main feature is a gradually increasing exophthalmos, usually without any impairment of vision.
The usual history has been that a perforation which showed no unusual features was sewn up and the patient left hospital apparently well, only to return some months later with an abdominal swelling which ultimately proved to be due to an actinomycotic lesion. In the case recorded by Keynes a year elapsed between the suture of the perforation and the return of the patient with an actinomycotic liver ; in this patient at autopsy there was found a small abscess containing colonies of the fungus in the scar tissue underlying the site of the ulcer.