216 HOOTON. 



mycetoma and callosities to a prick of a thorn. The photograph (Plate 

 I, fig. 1) shows a case in which there were many callosities on the soles 

 of both feet; Plate 1, fig. 2, the two conditions occurring side by side in 

 the same foot; and Plate I, fig. 3, a distinct patch of mycetoma with 

 another internal to it which, I think, is progressing toward a condition 

 of horny degeneration. As regards the disease shown by Plate II, fig. 4, 

 I do not wish to discuss the point; it represents a condition which I have 

 never observed before, and I should be very glad if light could be thrown 

 upon it. 



Another stage of the disease, the existence of which has been denied by 

 some authorities, is shown in Plate II, figs. 5 and 6. I am aware that 

 secondary deposits in the lymphatic glands have been previously reported, 

 but these are the only two cases which I have personally seen. In this 

 form mycetoma would appear to be as dangerous as and more rapid in 

 its spread than some varieties of carcinoma; but fortunately such a 

 development is very rare. Recurrence at the site of amputation is 

 apparently even more rare, and I have only once seen a case in point; 

 in this the growth recurred in the flop after a Syme's amputation. My 

 own experience in all cases where there seems to be any reasonable pros- 

 pect of extirpating the fungus in that way leads me to excise the growth, 

 in preference to sacrificing the foot, even though it may be impossible 

 to allow a very liberal margin of sound tissue. The results of treatment 

 are satisfactory in ordinary cases, and in the malignant type probably 

 even amputation woiild fail. 



Of the 26 patients above referred to, 18 were males, and 13 cultivators 

 by occupation. Fifteen of the growths discharged black granules and 11 

 yellow granules. 



