CHAPTER VII, 

 MYCETOMA, OR MADURA-FOOT. 



ACTINOMYCES MADURA. 



General Characteristics. A non-motile, non-flagellate, sporogen- 

 ous (?), non-liquefying, chromogenic, aerobic and optionally anaerobic, 

 branched, parasitic organism belonging to the higher bacteria, staining 

 by ordinary methods and by Gram's method, and pathogenic for man. 



A curious disease of not infrequent occurrence in the 

 Indian province of Scinde and of rare occurrence in other 

 countries is known as mycetoma, Madura-foot, or pied de 

 Madura. Although described as peculiar to Scinde, the dis- 

 ease is not limited to that province, but has been met with 

 in Madura, Hissar, Bicanir, Delhi, Bombay, Baratpur, 

 Morocco, Algeria, and in Italy. In America less than a 

 dozen cases of the disease have been placed on record. In 

 India it almost invariably affects natives of the agricultural 

 class, and in nearly all cases is referred by the patient to 

 the prick of a thorn. It usually affects the foot, more 

 rarely the hand, and in one instance was seen by Boyce 

 to affect the shoulder and hip. It is more common in 

 men than in women, individuals between twenty and forty 

 years of age suffering most frequently, though persons of 

 any age may suffer from the disease. It is insidious in onset, 

 no symptoms being observed in what might be called 

 the incubation stage, which is of a couple of weeks' 

 duration, but a nodular growth forming in the course of 

 time and gradually attaining the size of a marble. Its 

 deep attachments are indistinct and diffuse. The skin 

 over it becomes purplish, thickened, indurated, and ad- 

 herent. The ball of the great toe and the pads of the 

 ringers and toes are the points most frequently invaded. 

 Although very slowly, the lesions progress very percepti- 

 bly, and in the course of a few months form distinct 

 inflammatory nodes. After a year or two the nodes 

 begin to soften, break down, discharge necrotic and 

 purulent material, occasioning the formation of ulcers 



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