Intra-Thoracic Actinomycosis Presenting as Empyema

REPORT OF A CASE By R. A. PYPER, M.D., M.R.C.P.(LOND.) Royal Victoria Hospital, Belfast. TIHORACIC aCtinonimycosis, a comparatively unicommon coniditioni, miay -arise by direct inhalation of the inifectinig organism, by metastatic spread from a focus elsewhere, or by infiltration through the cesophagus. It may present as a broncho-pneumonia or as a lung abscess; it may closely simulate pulmonary tuberculosis or spreading suppurative pneumonitis; nexv growth or bronchiectasis may he suggested; sometimes, as in the present case, there is an empyema. Diagnosis is not usually establishedl until the organism is found(I in sputum or in pus from a surgically drained abscess; sometimes Inot until "sulphur granules" appear in pus lromil on(e or mainiy (lischiargilig sinluses in thie chest-w\\all. 1if empyenma hias occurred diagnosis may be made 1b t1ioracentesis. If the progress of tlle abschess-formiinag gralllomatouLs lesioni remicaills ucllecked the result is (lisastrous, and in pre-penicillin (lays few patiejnts survived miiore thani than l y'ear or txwo. I'he ouitlook is niow more hopeful, but a (lefinlite linle of satisfactory treatmetnt does not as yet appear to have been finally decided, particularly With reference to the dosage of penicillin xvlich slhould tic employed, andl the length of time for xvhich it should be continued.