MADURA DISEASE. 293 



similar parasite, though it is now pretty certain that the 

 organisms in the two conditions are of different species. 

 This disease is comparatively common in India and in 

 various other parts of the tropics. It most frequently 

 affects the foot ; hence the disease is often spoken of 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 occur 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 actinomyces, are present. 

 These may have a yellowish or pinkish colour, compared 

 from their appearance to fish roe, or they may be black 

 like grains of gunpowder, and may by their conglomeration 

 form nodules of considerable size. Hence a yellow or pale, 

 and a black variety of the disease have been distinguished. 

 In both varieties the granules mentioned reach a rather 

 larger size than in actinomycosis. 



When the roe-like granules are examined microscopically, 

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

 interior an abundant mass of branching filaments with 

 mycelial arrangement. There are also present at the peri- 

 phery, structures which have a resemblance to the clubs in 

 actinomyces. 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. In the black variety, in many cases, the 

 pigment is so abundant that all internal structure is 

 obscured. In some cases, however, filaments may be found 

 as in the yellow variety. As a rule, however, the parasite 

 appears to be in a more or less degenerated condition, and 

 the tissue round about the black masses is usually fibrous 

 in character, their presence not being associated with much 

 softening. 



