MADURA FOOT 553 



Madura Disease or Mycetoma 



Madura disease, otherwise known as madura foot, mycetoma, or 

 the " fungus disease of India," is a chronic local affection generally 

 attacking the foot, occasionally the hand, sometimes extending up 

 the leg, but rarely to the trunk. The disease was originally 

 described in India, where it is fairly common in certain districts, 

 but similar affections (due to a variety of organisms) are met 

 with in other parts of Asia, in Europe, Africa and America. A 

 " madura " foot appears enlarged, and numerous sinuses with 

 raised mammillated apertures open on the surface (Fig. 52). On 

 making a section into the diseased tissues the bones are more or 

 less carious, while the soft structures are tough and hypertrophied 

 from the occurrence of chronic inflammatory changes. Numerous 

 small cavities are present, sometimes filled by yellowish granules 

 resembling fish-roe, and hence termed " roe-like particles," at 

 others containing black particles of irregular shape, coal-like 

 consistence, and variable size, exceptionally as large as a marble 

 or walnut. The presence of the white or black granules, which 

 may be discharged from the sinuses before mentioned, divides the 

 disease into two classes the so-called white and black varieties. 

 Lewis and Cunningham also described a third variety, in which 

 the granules are red like cayenne pepper. 



Vandyke Carter l first called attention to the similarity between 

 the white variety and actinomycosis in their microscopical 

 characters. In sections stained by Gram's method more or less 

 crescentic or reniform bodies are noticeable, divided into wedge- 

 shaped areas, which contain masses of fine filaments stained 

 purple. Surrounding the crescentic bodies is a zone of radially 

 arranged elements, many of which are fan-shaped owing to 

 branching ; they are indistinct, as they do not stain with the 

 gentian violet, but they are very suggestive of the club-shaped 

 structures present in actinomycosis, and they resemble the 

 Actinomycosis hominis, inasmuch as they do not stain by Gram's 

 method (Plate XXI, b). By staining with hsematoxylin and 

 orange-rubin, or with the Ehrlich-Biondi triple stain, here and there 

 in the radial zone well-defined clubs can be demonstrated. It 

 seems, therefore, that the radial zone is composed of degenerate 



1 Bombay Med. and PTiys. Soc., vol. ix, 1886 (new series), p. 86 ; also 

 Hewlett, Trans. Path. Soc. Lond.. vol. xlii, 1893. 



