CHAPTER VI. 



MYCETOMA, OR MADURA-FOOT. 



A CURIOUS disease of not infrequent occurrence in the 

 Indian province of Scinde is one known as mycetoma, 

 Madura-foot, or pied de Madura. It almost invariably 

 affects natives of the agriculturist class, and in most 

 cases begins in or is referred by the patient to the prick 

 of a thorn. It generally affects the foot, more rarely 

 the hand, and in one instance was seen by Boyce in the 

 shoulder and hip. It is more common in men than in 

 women, individuals between twenty and forty years of 

 age suffering most frequently, but persons of any age or 

 sex may suffer from the disease. It is insidious in its 

 onset, as has been said, generally following a slight 

 injury, such as the prick of a thorn. No symptoms are 

 observed in what might be called an incubation stage of 

 a couple of weeks' duration, but after this time elapses a 

 nodular growth gradually forms, attaining in the course 

 of time the size of a marble. Its deep attachments are 

 indistinct and diffuse. The skin becomes purplish, 

 thickened, indurated, and adherent. The points most 

 frequently invaded at the onset are the ball of the great 

 toe and the pads under the bases of the fingers and toes. 



In the course of months, although progressing slowly, 

 the lesions attain very perceptible size, distinct tumors 

 being present. Later, sometimes not until after a year 

 or two, the nodes begin to soften, break down, discharge 

 their purulent contents, and originate ulcers and com- 

 municating sinuses. The discharge at this stage is a 

 thin sero-pus, and is always mixed with a number of 

 fine round black or pink bodies, described, when black, 

 as resembling gunpowder ; when pink, as resembling 

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