File:Medical diagnosis for the student and practitioner (1922) (14782398164).jpg

Identifier: medicaldiagnosi00gree (find matches)
Title: Medical diagnosis for the student and practitioner
Year: 1922 (1920s)
Authors: Greene, Charles Lyman, 1862-
Subjects: Diagnosis
Publisher: Philadelphia, Blakiston
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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ing fistulae H3° MEDICAL DIAGNOSIS leading from the surface to deep-seated granulomatous areas, which prove tobe casting off small granules similar to those present in true actinomycosis. As a rule but one form is present and, according to Stitt, this usually is theNocardia madurce, showing pallid fish-roe like granules. Nocardia asteroidesand others may be causative, and a discharge of black granules like gunpow-der grains indicates the presence of Madurella mycetomi, Aspergillus bouffardi,or Sporotrichum beurmanni. The disintegration of the tissues may be so great as to convert the footinto a mere cheesy mass, and an inflammatory edema is constant. Atrophy of the leg on the side affected serves to emphasize the deformity.Pain is slight or absent and relief is sought by the natives because of theburden imposed by the enormously enlarged useless member. Amputation is the only procedure of value, and cases are seldom seen inthe earliest stage when there is a mere swelling of the sole.
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Fig. 545.—Madura hand. (After Carter.) Pseudotuberculosis Hominis Streptotricha.—As stated elsewhere thenocardoses may present a clinical picture almost indistinguishable from thatof tuberculosis of the lungs, and cause pyorrhea, stomatitis, quinsy, enteritis,and even appendicitis in rare instances. The streptothrix is acid fast but less obdurate than the tubercle bacillus.It tends to branching forms and its units are longer and of equal length. In the stomach it may be taken for the Boas-Oppler bacillus. Another unpleasant quality is that of forming metastases in distantorgans. In relation to this as to so many other of these rare conditions the diag-nosis depends chiefly upon remembrance of the fact that such causes of dis-ease exist and that the very terms syphilis and tuberculosis, especially,must carry with them the suggestion of the nocardoses and mycoses asrare possibilities. ACTINOMYCOSIS.—This disease which also belongs to the infectivegranulomata is caused by the Strep

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