THE HIGHER BACTERIA 627 



MYCETOMA (MADURA FOOT) 



The disease known by this name is not unlike actinomycosis. It 

 is more or less strictly limited to warmer climates and was first recog- 

 nized as a clinical entity, in India, by Carter. 1 Clinically it consists 

 of a chronic productive inflammation most frequently attacking the 

 foot, less often the hand, very infrequently other parts of the body. 

 Nodular swellings occur, which break down in their centers, leading to 

 the formation of abscesses, later of sinuses. Often the bones are in- 

 volved and a progressive rarefying osteitis results. From the sinuses a 

 purulent fluid exudes, in which are found characteristic granular bodies. 

 These may be hard, brittle, and black, resembling grains of gunpowder, 

 or may be grayish-white or yellow and soft and grumous. According to 

 the appearance of these granules, two varieties of the disease are dis- 

 tinguished, the "melanoid" and the "ochroid." Many observers 

 believe that the yellow or ochroid variety is, in fact, actinomycosis. 

 The black variety, which is certainly a distinct disease, is caused by a 

 member of the hyphomycetes group. The parasite has been carefully 

 studied by Wright, 2 from whose description the following points are 

 taken : 



The small, brittle granules observed under the microscope show a 

 dark, almost opaque center along the edges of which, filaments, or 

 hyphse, may be seen in a thickly matted mass. By crushing the granules 

 under a cover-slip in a drop of sodium hypochlorite or of strong sodium 

 hydrate, the black amorphous pigment is dissolved and the structural 

 elements of the fungus may be observed. They seem to be composed 

 of a dense meshwork of mycelial threads which are thick and often 

 swollen, and show many branches. Transverse partitions are placed 

 at short distances and the individual filaments may be very long. 

 Spores were not observed by Wright. In a series of over fifty cultiva- 

 tions on artificial media from the original lesion, Wright obtained growth 

 in a large percentage. 



In broth, he obtained at first a rapid growth of long hyphse which 

 eventually formed a structure which he compares in appearance to a 

 powder-puff. 



On agar, growth appeared within less than a week and spread over 

 the surface of the medium as a thick meshwork of spreading hyphae 



1 Carter on Mycetoma, etc., London, 1874. 

 Wright, Jour, of Exper. Med., 3, 1898. 



