Mycetoma. 337 



istic of mycetoma appeared one after the other, and from the apices of each, 

 through the minute opening situated thereon, these grain-like masses were 

 'discharged. 



"A year ago the enlargement became very marked, and since then 

 lias become enlarged, attended with pain. After the discharge of the 

 granules, the pain, which increases until then, becomes less, and he gets 

 •relief until the tubercles are again ready to discharge. 



" He is anxious to have the foot removed, 



"Has never been in black cotton soil ; has never had guinea worm. 

 Some ten years previous to the appearance of the white patch, he was 

 pricked by a thorn in the sole, near the middle of the bases of the toes. 

 After that he was laid up for a month. Through the opening a slough 

 was discharged, and the granulations were exulcerant, which were 

 destroyed by some caustic application. 



"He was only able to walk three months after the receipt of the 

 injury." 



In this specimen the front of the foot has been distended 

 €ven more than in the previous case, and the bones have beep 

 more extensively affected. The tubercles on the surface are 

 fewer and smaller. There are few tunnels to be seen, and 

 granules only here and there. G. C. 2510. 



Presented by Surgeon Tyrrell, H.M. Madras Army. 



6. 352. Mycetoma or Fungus Foot of India.— Bones of the 



foot and lower end of the tibia and fibula of a native, aged 30 — 

 macerated, illustrating the above. 



Amputation was performed through the leg and the patient 

 recovered. 



The OS calcis and astragalus are marked by numerous 

 circular pits and erosions on their surface, some of these 

 passing deeply into the bone, and in some places honeycombing 

 it. At the margins of the posterior surface of the os calcis 

 there are numerous projecting portions of new periosteal bone. 

 The other tarsal bones have been almost entirely destroyed, and 

 are represented in most cases by an imperfect shell containing 

 some atrophied cancellous tissue. The bases of the metatarsal 

 bones are in a similar condition, and in some cases the shafts 

 also. The tibia and fibula have been attacked in a simikir way 

 Y 



