Synonyms:—Lumpy jaw; big jaw; wooden tongue.

Definition:—An infectious disease, chronic in character, supposed to originally develop in cattle and swine and from them conveyed to man. It is caused by the presence of the ray fungus, the streptothrix actinomyccs.

Etiology:—The origin of the ray fungus is unknown, but there has long been a theory, which is not yet exploded, that it develops on the seeds, perhaps of certain grasses, primarily in much the same manner that ergot develops upon corn and rye. There is no proof that it has ever been conveyed directly from one animal to another, or from man to man, and the exact origin of the disease in the most of the cases observed in man cannot be determined.

It is supposed to occur from the eating of meat which is infected, and there are doubtless other sources of introduction. The fungus finds entrance to the tissue through an abrasion, or it will enter the jaw, where it usually develops first, through a carious tooth. It develops also in the lungs and in the stomach and intestinal canal.

Symptomatology:—The appearance of the disease in the tissues of the jaw, tongue, neck or throat is in the form of microscopic masses—minute tubercles—which develop into small granules or nodules of a yellowish white color, containing caseous matter and ultimately pus. The intervening tissues thicken and enlarge with the growth of the nodules, forming a nodulated tumor, which is progressive in growth. Cavities ultimately form from suppuration in the different nodules, which become connected by sinuses. The disease develops in the lungs and bronchi, with cough and the usual signs or irritation and congestion, with some local hepatization. Emaciation, hectic fever and general prostration are present, and the expectoration of a purulent substance, in which the actinomyces are found.

Diagnosis:—The diagnosis depends specifically upon the presence of the micro-organism. However, to one at all experienced, the evidences, when the condition has developed, are unmistakable. There is but little difficulty in differentiating between this and necrosis and sarcoma of the jaw.

Treatment:—No internal remedial measures alone have yet produced satisfactory results. The removal of the diseased tissues by the knife is important, and the use of active antiseptics in the disinfection of the wounds. The injection of carbolic acid solution into the surrounding tissues is productive of good results.

The use of the potassium iodid to a full saturation of the system has produced good results. Calcium sulphid will also be of service. We have much faith in the action of our active vegetable alteratives in preserving the integrity of the vitality within the system and in sustaining the function of the organs of nutrition and appropriation.

When constitutional symptoms develop they should be met as indications suggest. The combating of these symptoms will retard the progress of the disease and will further the chances of ultimate recovery.

The Eclectic Practice of Medicine with especial reference to the Treatment of Disease, 1910, was written by Finley Ellingwood, M.D.