338 ACTINOMYCOSIS AND ALLIED DISEASES 



the colonies may be recognised with the naked eye, especially 

 when some of the pus is spread out on a piece of glass. If one 

 of these is washed in salt solution and examined unstained, the 

 clubs, if present, are at once seen on microscopic examination. To 

 study the filaments, a colony should be broken down on a cover- 

 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-thionin-blue, or by carbol-fuchsin diluted 

 with five parts of water. If the specimen be overstained, 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 



