MADURA DISEASE 



339 



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 

 enlargement and distortion of the part and frequently caries and 

 necrosis of the bones. Within the softened cavities and also in 

 the spaces between the fibrous tissue, small rounded bodies or 

 granules, bearing a certain resemblance to the actinoinyces, are 

 present. These may have a yellowish or pinkish colour, com- 

 pared from their appear- 

 ance to fish roe, or they 

 may be black like grains 

 of gunpowder, and may 

 by their conglomeration 

 form nodules of consider- 

 able size. Hence a pale 

 variety and a black 

 variety of the disease 

 have been distinguished ; 

 in both varieties the 

 granules mentioned 

 reach a rather larger 

 size than in actinomy- 

 cosis. These two condi- 

 tions will be considered 

 separately. 



Pale Variety. When 

 the roe-like granules are 

 examined microscopic- 

 ally they are found, like the actinomyces, to show in 

 their interior an abundant mass of branching filaments with 

 mycelial arrangement. There may also be present at the peri- 

 phery club-like structures, as in actinomyces ; sometimes they 

 are absent. These structures often have an elongated wedge- 

 shape, forming an outer zone to the colony, and in some cases 

 the filaments can be found to be connected with them. Vincent 

 obtained cultures of the parasite from a case in Algiers, and 

 found it to be a distinct species : it is now known as the 

 streptothrix or discomyces Madurcz. Morphologically it closely 

 resembles the actinomyces, but it presents certain differences in 

 cultural characters. In gelatin it forms raised colonies of a 

 yellowish colour, with umbilication of the centre, and there is 

 no liquefaction of the medium. On agar the growth assumes a 



FIG. 102. Streptothrix Madurse, showing 

 branching filaments. From a culture on 

 agar. 

 Stained with carbol-thionin-blue. x 1000. 



