﻿ETIOLOGY OF MYCETOMA. 489 



In November, 1859, Carter examined a foot before and after amputa- 

 tion, and found in it and in the discharges from the openings on the 

 surface "numerous minute, pale particles, which also presented a decided 

 fungus structure." The fungus-like appearance of these bodies was 

 subsequently confirmed, Carter says, by the members of the Medical and 

 Physical Society to whom he showed his specimens at one of their 

 meetings. Therefore, Carter concluded that although there were ap- 

 parent differences between the fungi of the pale and black t} r pes, and that 

 those of the former were very peculiar structures, Chionyphe could be seen 

 to spring from the particles (sclerotia) obtained from them as well as 

 from those of the black variety, and it was his opinion that the two forms 

 are but varieties or different stages of the same disease. 



After further discussion Carter concludes as follows : 



"The foot disease of India is not a carious, strumous, or myeloid, or any 

 like affection; but a veritable parasitic disease, due to the growth and extension, 

 within the tissues of the human foot, of an indigenous mould or fungus of true 

 plant nature." 



It is apparent from a review 13 of his monograph 14 that Dr. Carter 

 was a pioneer in his observations in the establishment of the cause of 

 the disease, and in maintaining the identity of the two varieties. How- 

 ever, the reviewers of his monograph criticized Carter's conclusions and 

 pointed to the lack of evidence submitted by him in support of the 

 parasitic nature of the so-called fungus. 



Corre (1883), in reporting the notes of Dr. Collas, states that the latter 

 observer considered Epulis gravis, the pseudo-cancer of the inferior maxilla found 

 in Pondicherry, to be identical with mycetoma. Vincent, Roux (1888) and Brun 

 (1893) describe the early symptoms of the disease; Lebroux (Bordeaux 1887) 

 in a thesis (not available to us) discussed the whole subject of mycetoma and 

 Bassini (1888) reported a case (the first in Europe) of melanoid mycetoma which 

 occurred in Italy. He recognized the fungus nature of the granules, the radiat- 

 ing type of the filaments and the irregular swellings in segments. He considered 

 them to be somewhat of the nature of the Aspergilli or Muoorini. Bassini's 

 patient pricked his foot in an ox stall ; the wound healed, but a tumor developed 

 and by the seventh or eighth month the patient could not walk. The fungus was 

 found in the typical tumor removed at operation, but attempts at cultivation 

 were not successful. 



The decade from 1890 to 1900 furnished a number of interesting contributions 

 to the subject. 



Hewlett (1892 and 1893') in his first article described findings obtained from 

 the study of a preserved specimen sent from India and concluded that mycetoma 

 is identical with actinomycosis. In his second paper he reports two cases of the 

 ochroid variety, and reiterates his belief that the process is the same as actino- 

 mycosis. 



Kanthack (1892 and 1893) studied sections from the prepared material obtained 

 from three cases of the black variety ; he noted the fungoid elements and although 



"Lancet (1874), 591. 



""On Mycetoma or the Fungus Disease of India, Lond." (1874), 113. 



