CHAPTER XXXIV. 



MYCETOMA, OR MADURA-FOOT* 



ACTINOMYCES MADURA (VINCENT). 



General Characteristics. A non-motile, non-flagellate, sporogen- 

 ous (?), non-liquefying, non-aerogenic, chromogenic, aerobic and option- 

 ally anaerobic, branched, parasitic organism belonging to the higher 

 bacteria, staining by ordinary methods and by Gram's method, and 

 pathogenic for man. 



A curious disease of not infrequent occurrence in the 

 Indian province of Scinde and of rare occurrence in other 

 countries is known as mycetoma, Madura-foot, or pied de 

 Madura. Although described as peculiar to Scinde, the dis- 

 ease is not limited to that province, 

 but has been met with in Madura, 

 Hissar, Bicanir, Delhi, Bombay, 

 Baratpur, Morocco, Algeria, and in 

 Italy. In America less than a 

 dozen cases of the disease have been 

 placed on record. In India it al- 

 most invariably affects natives of 

 the agricultural class, and in nearly 

 all cases is referred by the patient 

 to the prick of a thorn. It usually 

 affects the foot, more rarely the 

 hand, and in one instance was seen 

 by Boyce to affect the shoulder and 

 hip. It is more common in men 

 than in women, individuals between 



^^ and fort y y ears of ^ suffer- 

 ing most frequently, though persons 

 of any age may suffer from the 



disease. It is insidious in onset, no symptoms being ob- 

 served in what might be called the incubation stage of a 

 couple of weeks' duration, except the formation of a nodular 

 growth which gradually attains the size of a marble. Its deep 

 attachments are indistinct and diffuse. The skin over it 

 becomes purplish, thickened, indurated, and adherent. The 



812 



Fig. 269. Madura-foot 

 mycetoma (Musgrave 

 and Clegg). 



