Royal Microscojyical Society. 67 



bear evidences of the characteristic poison. Such a specimen as I 

 have been discussing, without a particle of fungus, is enough to in- 

 vahdate and destroy the superstructure upon which Dr. Carter 

 builds his hypothesis of the "" fungoid foot" ; and my objection is in 

 no wise met by saying that this form of disease is exceptional, and 

 the appearances observed are those of " degenerate fungi," &c. To 

 this I reply, it is apparently a form often met with. Mr. Henry J. 

 Carter, F.K.S., in his early investigations of the disease, found only 

 a large quantity of albuminoid and fatty matters, and attributed 

 the changes observed to fatty degeneration. He, however, subse- 

 quently examined other specimens in which he discovered fungi, 

 and changed his opinion, but he adds, " I could scarcely overcome 

 the difficulty in believing it possible for a fungus to destroy the 

 bones as well as the other tissues of the foot." Another excellent 

 observer, Dr. Bristowe, a gentleman who has examined several 

 specimens of the disease, writes : — " Although the soft parts are in- 

 filtrated with a lump of truffle-like bodies, I am not prepared to 

 say that the fungus causes the disease ; it rather seems to me pro- 

 bable that the primary disease was caries of the bones, and that the 

 fungus became developed subsequently and accidentally. The 

 latter view is supported by the nature of the foot which you 

 examined." I feel bound to believe with Dr. Bristowe that the 

 disease is due to caries of the bones; occurring, perhaps, in a 

 strumous, scrofulous, or syphilitic constitution. In caries, we find 

 a similar train of pathological appearances; the bony structures 

 are filled with a sanious, or glary fluid, soft granulations springing 

 up, and a deposit of tuberculous material, with an increase of fat, 

 causes complete destruction of the bones. The slow disintegration 

 of the various structures in the Madura foot disease is exaggerated 

 by the ordinary efiects of a tropical chmate, often an imjDortant 

 factor in disease, and one well exemplified in those remarkable 

 forms elephantiasis and leprosy, both of which seem to originate in 

 a metamorphosis of cell contents, a condition not unfrequently 

 noticed in pathological anatomy. The deposition of fat in cells and 

 structures of all kinds is perhaps of all changes the most curious 

 and universal. A beautiful series of transformations is often traced 

 in fat-cells, which, according to the deficiency or excess of nutritive 

 fluid, lose, in the former case their contents, and eventually con- 

 tain only serum, in the latter become distended with fat-globules ; 

 further, in the cells of glands secreting fat, which, at fii'st poor in 

 fat, are ultimately quite distended with it. Also in the ova of all 

 animals which deposit fat and proteine within themselves. 



In the case before us of the Madura foot, the fatty degeneration, 

 or disintegration, commences in the bones of the foot, and physio- 

 logical phenomena are gradually merged into pathological. A 

 similar instance in presented in the amyloid " Lardaceous " disease, 



