MADURA DISEASE 297 



cover-glass, dried, and stained with a simple solution of any of 

 the basic aniline dyes, such as gentian-violet, though better 

 results are obtained by carbol-thionin-blue, or by carbol-fuchsin 

 diluted with five parts of water. If the specimen be over-stained, 

 it may be decolorised by weak acetic acid. Cover-glass prepara- 

 tions of this kind, and also of cultures, are readily stained by 

 these methods, but in the case of sections of the tissues Gram's 

 method, or a modification of it, should be used to show the 

 filaments, etc., a watery solution of acid fuchsin being afterwards 

 used to stain the clubs. By this method, very striking prepara- 

 tions may be obtained. 



Cultures should be made both under aerobic and anaerobic 

 conditions. Tubes of agar or glycerin agar should be inoculated 

 and incubated at 37 C. ; deep tubes of melted glucose agar 

 should also be used, the inoculated material being diffused 

 through the medium, separate colonies may thus be obtained. 

 Owing to the slow growth of the actinomyces, however, the 

 obtaining of pure cultures is difficult, unless the pus is free from 

 contamination with other organisms. 



MADTJKA DISEASE. 



Madura disease or mycetoma resembles actinomycosis both 

 as regards the general characters of the lesions and the occurrence 

 of the parasite in the form of colonies or " granules." There is 

 no doubt, however, that the two conditions are distinct, and it 

 also appears established that the two varieties of Madura disease 

 (vide infra) are produced by different organisms. This disease 

 is comparatively common in India and in various other parts of 

 the tropics : it has also been met with in Algiers and in America. 

 Madura disease differs from actinomyces not only in its geo- 

 graphical distribution but also in its clinical characters. Its 

 course, for example, is of an extremely chronic nature, and 

 though the local disease is incurable except by operation, the 

 parasite never produces secondary lesions in internal organs. 

 Vincent also found that iodide of potassium, which has a high 

 value as a therapeutic agent in many cases of actinomycosis, had 

 no effect in the case of Madura disease studied by him. 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 



