MADUKA DISEASE 457 



hour to two hours. Place in methylated spirit until the sections 

 appear greenish, then pass through absolute alcohol and xylol. 

 The clubs are stained yellowish-brown, and are sometimes shown 

 in human cases when unstained by Gram's method. 



(c) By Plant's method. Stain in warm carbol-fuchsin for ten 

 minutes, rinse well in water, stain in a saturated solution of picric 

 acid in methylated spirit for five to ten minutes, rinse well in water, 

 place in 50 per cent, alcohol for ten minutes, pass through absolute 

 alcohol and xylol. 



(d) Good preparations may be obtained by staining in Ehrlich's 

 haematoxylin and counter-staining with orange rubin. This may 

 also show the clubs when they are unstained by Gram's method. 



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 occurs in certain 

 districts in India, and full descriptions of it have been given by 

 Vandyke Carter and by Lewis and Cunningham. A " madura " 

 foot appears enlarged, and numerous sinuses with raised mammilated 

 apertures open on the surface (Fig. 51). On making a section into 

 the diseased tissues the bones are found to be 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 resem- 

 bling 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 dis- 

 charged from the sinuses before mentioned, divides the disease into 

 two classes the so-called white and black varieties. Lewis and 

 Cunningham have 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 



1 Bombay Med. and Phys. Soc., vol. ix, 1886 (new series), p. 86. Also 

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



