PART II.] Forms tinder which the Affection Manifests Itself. 34 1 



as already mentioned, the Keverend M. J. Berkeley,* and Mr. H. J. Carter, F.R.S., f 

 published the result of their personal observations. The papers of these distinguished 

 observers were followed by those of many others, so that the bibliography of the disease 

 at ipresent occupies no inconsiderable space in our medical literature. Those of our 

 readers who may desire further details on this point will find a careful resume of the 

 greater part of what has been written concerning the disease in Dr. Carter's valuable 

 monograph. It will be sufficient for our purpose merely Ih refer, generally, to what 

 the three writers above mentioned have written, more especially to the writings of 

 Dr. Vandyke Carter and Mr. Berkeley, with whom chiefly rest alike the credit and 

 the responsibility which is attached to the observations and the deductions which have 

 been promulgated with regard to the disease. 



According to Dr. Carter the affection manifests itself under two forms, each 

 presenting a different state of the same disease: (1) the black or melanoid, sind (2) 

 the pale or ochroid^ varieties. There is, further, a phase of the disease characterised 

 by the presence in the tissues of pink granules, so that, practically, the malady has 

 been described as presenting three varieties. Although the phase of the disease last- 

 mentioned is of rare occurrence, it is, nevertheless, of great significance in connection 

 with the theory of the origin of the disease now commonly accepted — a view typified 

 in the name " Mycetoma " given to it by Dr. Carter and adopted by the London Royal 

 College of Physicians in its " Nomenclature of Diseases." 



As far as external appearances go, the two leading forms have mucb in common. 

 There is considerable distortion of the foot or hand affected, an increase of size, more 

 or less marked, in all directions ; there are numerous, somewhat mammillated, apertures, 

 communicating with cavities of various sizes and channels of various lengths in the 

 subjacent tissues. The materials which escape through these apertures differ in the two 

 forms : in the dark variety the fluid which oozes from the foot frequently contains 

 brownish-black granules, in appearance not unlike the rougher description of gunpowder ; 

 whereas in the pale variety little particles, bearing a considerable resemblance to fish- 

 roe, are very commonly seen. 



On section also the state of the hard and soft tissues presents much in common : 

 (a) numerous lined cavities generally communicating with each other by means of 

 sinuous channels ; (/>) softening and excavations, more especially of the tarsal and carpal 

 bones, but frequently also involving the long bones ; and (c) the packing of these 

 cavities with a hard, dark substance in the black variety, and with a more or less 

 soft, yellowish, fatty or gelatinous substance mixed with globular roe-like particles 

 in the other. 



It is with reference to the nature of these two substances, so different in appearance 

 to the naked eye, that Dr. Vandyke Carter's observations and deductions are of such 



* Intellectual Observer, No. X, November 1862. Journal of Linnean Society, Vol. VIII, p. 1.35, 1865. 

 t Annals and Mag;. Nat. Hist, Vol. IX, 1862. Journal of the Linnean Society, Vol. VIII, 1865. 



