338 



HCJIAN BOTBYOMTCOSIS 



As already mentioned, its pathological effects in animals hare been studied by a 

 few Continental observers. The horse, cow and hog appear to be more susceptible to 

 the disease than other animals. More recently its occurrence in man has also been 

 not«d by Bureau and Labbe. Bitter of Cairo has found it in Egj-ptian cases. 



Tendencr to 



Fibrotic 



change? 



The Clinical Signs of the Disease 



Males seem to be more commonly affected than females. One case occurred in a 

 native woman aged 45, who had suffered from a swelling in her breast since childhood. 

 For the past two years, however, the condition had occasioned her annoyance, and, on 

 presenting herself for treatment, the breast was found to be considerably inflamed, 

 exhibiting sinuses which exuded a greyish-white pus. The whole of the breast tissue 

 was involved, the growth simulating a fungating carcinoma, but the lymphatic glands 

 in the axilla and neck were not enlarged. The breast was excised by Dr. Hodson, of 

 the Sudan Medical Department, who kindly sent the specimen. 



From the histories obtained in the other cases, the disease appears to be more or 

 less a chronic one, commencing, as a rule, in the form of a superficial nodule, which 

 increases in size, and invades the deeper tissues, eventually involving fascia, muscle, 

 tendon, and sometimes bone. Specimens illustrating this are seen in the appended 

 photographs of the disease affecting the hand and foot where the resemblance to 

 mycetoma is a somewhat striking one. 



The tnmour of the scalp kindly sent by Captain Thomson, R..\.M.C., involved the 

 left occipito-temporoparietal region. The history of this case is of interest. 



The growth commenced about twelve months previously as a small lump about the size 

 of a date, and remained unchanged in dimensions till the patient was advised to have a 

 red hot iron passed into the tumour to kill it. This drastic treatment was carried out, 

 with the result that might be expected, namely, a marked increase in size. The tumour 

 was movable, but appeared to be adherent in parts to the subjacent bone. When the 

 growth was excised the subjacent bone was found to be soft and slightly infiltrated. 

 The sinuses on the surface exuded a thin watery pus containing yellow-white granules. 



The surface of this tumour was covered with sinuses around which were heaped up 

 masses of white fibrous tissue. This proliferating fibrous tissue was also present 

 around the openings of the sinuses in all the other specimens. The sinuses extended 

 to var}-ing depths, and were lined by granulation and necrosed tissue. In the hand and 

 foot specimens, they extended down to tendon and bone, leading to considerable 

 contracture and deformity. If a section be made through one of these growths its fibrotic 

 nature will be at once apparent, the intervening tissue between the sinuses consisting, for 

 the most part, of white fibrous tissue. This is frequently arranged in whorls, sharply 

 demarcating yellow hyaline-looking areas, which microscopically are seen to be composed 

 of groups of fat cells. Further, lying in this fibrous tissue, masses of yellow-brown 

 pigment are visible to the naked eye. 



The microscopical pathological changes are very constant, and consist of: — 



1. Marked proliferation of fibrous tissue which, in certain parts of the section, 

 appear to be undergoing myxomatous degeneration, more especially in the areas 

 surrounding the sinuses. Lying in this fibrous tissue are reticulated areas, which 

 contain fat globules. 



2. Round cell proliferation of a lymphoid type, suggesting the appearance of a 

 tubercle nodule (Plate XV., fig. 1). Giant cells are occasionally met with. 



