MADURA DISEASE. 271 



of this kind and also of cultures, are readily stained by 

 these methods, but in the case of sections of the tissues, 

 Gram's method, or a modification of it, should be used to 

 show the filaments, etc., a watery solution of rubin being 

 afterwards used to stain the clubs. By this method, very 

 striking preparations may be obtained. 



To obtain cultures, tubes of glycerine -agar should be 

 inoculated with portions of the colonies and incubated at 

 37 C., preferably both in the aerobic and anaerobic 

 condition. Owing to the slow growth of the actinomyces, 

 however, the obtaining of pure cultures is difficult, unless 

 the pus is free from contamination with other organisms. 



MADURA DISEASE. 



Madura disease or mycetoma in many respects closely 

 resembles actinomycosis, and is produced by a somewhat 

 similar parasite, though it is still doubtful whether the 

 organisms in the two conditions are of one and the same 

 species. This disease is comparatively common in India 

 and in various other parts of the tropics. It most frequently 

 affects the foot ; hence the disease is often spoken of as 

 " Madura foot." The hand rarely is affected. In the 

 parts affected there is a slow growth of granulation tissue 

 which has an irregularly nodular character, and in the 

 centre of the nodules there occurs purulent softening which 

 is often followed by the formation of fistulous openings and 

 ulcers. There occur great enlargement and distortion of 

 the part and frequently caries and necrosis of the bones. 

 Within the softened cavities and also in the spaces between 

 the fibrous tissue, small rounded bodies or granules, bearing 

 a certain resemblance to the actinomyces, are present. 

 These may have a yellowish or pinkish colour, compared 

 from their appearance to fish roe, or they may be black 

 like grains of gunpowder, and may by their conglomeration 

 form nodules of considerable size. Hence a yellow or pale, 

 and a black variety of the disease have been distinguished. 



