342 HUMAN BOTKYOMVCOSIS 



more hyaline in consistence. Even when enclosed within the cell and prior to rupture 

 of the cell envelope, these coccal masses sometimes undergo degenerative changes, 

 taking on almost a neutral staining tint, showing neither a distinct affinity for tlie 

 hu'mateiii nor for the eosin. 



Similar staining reactions were obtained with Leishman's stain, the coccal masses 



taking up the nuclear stain when occupying a position within the cell envelope, and 



showing an affinity for the eosin when extra-cellular, appearing at the same time more 



hyaline-looking and structureless in contrast to the granular and often vacuolated 



appearance exhibited when occupying their intra-cellular position. Sections stained 



with iron liaematoxylin iihiiii and counter-stained with saffranin show very well the 



central nuclear structure of these individual botryoniyces surrounded by a saffranin 



staining rim of cytoplasm, which, in some cases, appears striated. 



Further work requires to be done to establish the exact nature of these botryomyces, 



and their possible mode of transmission to man. As already stated, considerable assistance 



would be obtained if one had access to fresh pathological material, but so far opportunities 



for this have been lacking. In animals the disease is transmitted by direct infection 



through a wound or abrasion of the skin, especially in those parts of the skin subjected 



to friction. Man, in all probability, becomes infected in a similar manner, but the 



possible role played by ticks and other biting insects would have to be considered. 



Conclusions 



Possible From the fact that a streptothrix condition was present in three of the tumours 



connection g j. j^j. examination, one is inclined to come to the conclusion that botryomycosis is 



with a ' . . 



strcptothricosis really a streptothricosis and that the clumps of botryomyces in reality represent the 



gonidia of possibly a new and hitherto undescribed species of streptothrix. 



Reference has been made to all the literature available here including Brumpt's' 

 excellent monograph entitled " Les mycetomes" but one has failed to find any work giving 

 a similar description of these botryomyces. 



Further, the clinical appearances of three of the tumours certainly support the 

 streptothrix theory of this disease. Before concluding, reference may be made to the 

 amoebic theory of the disease put forward by Bureau and Labb6.'- These observers found 

 in a case of botryomycosis of the finger, a large amoeba measuring 50^ to 60^ thus 

 apparently confirming Letulle's-' previous view that possibly botryomycosis is amoebic in 

 origin. Several staining methods have been employed with the view of confirming, if 

 possible, Labb6 and Bureau's amoebic theory, but so far without success. Certainly it 

 is difficult to associate such a large amount of destruction of dense tissue as is met with 

 in botrj'omycosis with the presence of an amoeba. 



' Brnmpt, E. (November 25, 1906), "Lcs mycetomes." Arch, rle Parnsil., Vol. X., No. 4. 



' Biironn, O., and Lablir, A. (.Inly 1.5, 1909), "Siir raffectioQ conmio sous Ic noin do liotryomycose et son 

 parasite." Bullelin dr I'Instiliil PiiKteur. 



=■ LetuUe, M. (July 15, 190S), " l^a botryomycose." Hiillctiii ile Vln.ilUnl I'nsUur. 



