MYCETOMA 481 



minute coloured granules about the size of fish roe. The whole foot 

 is much enlarged, especially in thickness, its shape is lost, anatomical 

 points are obliterated, multiple sinuses reach the surface and discharge 

 through their sinuses with distinctive odour. As the foot enlarges 

 the leg atrophies from disuse, thus making the foot enlargement the 

 more noticeable. Pain is usually absent; locomotion is difificult; the 

 skin sensibility is normal ; pitting is not obtained, but the tissue is 

 elastic. 



There is no spontaneous healing, and after eight to twelve years of 

 exhaustion, diarrlura often carries off the patient. 



VARIETIES. 



(^4) The Melanoid Group. 



(i) Carter's black mycetoma. 



Parasite, ]\Iadurella mycetoma, Laveran, 1902. 

 The sclerotia are small, hard and blackish. 

 The parasite throws off a blackish debris. 



(2) Boufifard's black mycetoma. 



Parasite, Aspergillus bouffardi, Brumpt, 1905. 



The grains are larger and more elastic than the above. 



Curetting may cure this condition. 



(3) Nicolle and Pinoy's black mycetoma. 

 Parasite, Madurella tozeuri, Nicolle, 1908. 



(4) Link's black mycetoma. 



Parasite, Penicillium glaucum. Link, 1915. 



(B) The Ochroid Group. 



(i) Carter's white mycetoma. 



Parasite, Nocardia madura?, \'incent, 1894. 



The sclerotia are whitish, mulberry-like and spherical. 



(2) Actinomycotic white mycetoma. 



Parasite, Nocardia bovis and Israeli, 1872 and 1896. 

 The sclerotia are yellowish, sulphur colour and soft. 

 It destroys bones and forms metastases throughout the bodv. 



(3) Nicolle's white mycetoma. 



Parasite, Sterigmatocystis nidulans, Eidans, 1883. 

 The sclerotia are large, like peas, and smooth. 

 It attacks bone. 



(4) Brumpt's white mycetoma. 

 Parasite, Indiella mansoni, 1906. 



The sclerotia are small and white, occurring as hard bean- 

 shaped granules. 



(5) Reynier's white mycetoma. 

 Parasite, Indiella rejieri, 1905. 



The small white sclerotia occur in soft coiled masses. 



