328 ACTIffOMYCOSIS AND ALLIED DISEASES 



glass, dried, and stained with a simple solution of any of the 

 basic aniline dyes, such as gentian-violet, though better results 

 are obtained by carbol-thion in-blue, or by carbol-fuchsin diluted 

 with five parts of water. If the specimen be over-stained, it 

 may be decolorised by weak acetic acid. Cover-glass pre- 

 parations 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 acid fuchsin being after- 

 wards used to stain the clubs. By this method, very striking 

 preparations may be obtained. 



Cultures should be made both under aerobic and anaerobic 

 conditions. Tubes of agar or glycerin agar should be inoculated 

 and incubated at 37 C. ; deep tubes of melted glucose agar 

 should also be used, the inoculated material being diffused 

 through the medium, separate colonies may thus be obtained. 

 Owing to the slow growth of the actinomyces, however, the 

 obtaining of pure cultures is somewhat difficult, unless the pus is 

 free from contamination with other organisms. 



MADURA DISEASE. 



Madura disease or mycetoma resembles actinomycosis both as 

 regards the general characters of the lesions and the occurrence 

 of the parasite in the form of colonies or "granules." There is 

 no doubt, however, that the two conditions are distinct, and it 

 also appears established that the two varieties of Madura disease 

 (vide infra) are produced by different organisms. This disease 

 is comparatively common in India and in various other parts of 

 the tropics : it has also been met with in Algiers and in America. 

 Madura disease differs from actinomycosis not only in its geo- 

 graphical distribution but also in its clinical characters. Its 

 course, for example, is of an extremely chronic nature, and 

 though the local disease is incurable except by operation, the 

 parasite never produces secondary lesions in internal organs. 

 Vincent also found that iodide of potassium, which has a high 

 value as a therapeutic agent in many cases of actinomycosis, had 

 no effect in the case of Madura disease studied by him. It most 

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

 as "Madura foot." The hand is rarely 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 are great 



