﻿490 MUSGRAVB AND CLEGG. 



lie "found it difficult to convince himself of their vegetable nature," he thought 

 that they might be degenerating types of an organism similar to Actinomyces. 

 Kanthack also examined sections from preserved material taken from twelve 

 cases of the ochroid variety, and states that "the parasite of the oehroid variety 

 agrees morphologically and structurally with the typical and perfect ray fungus, 

 and there can be no reasonable doubt that both belong to the same botanical 

 group." Kanthack concludes that " ( 1 ) the fish-roe masses are undoubtedly a 

 form of actinomyces ; (2) the black masses in their most perfect shape are also 

 of this nature, but in a state of degeneration ; ( 3 ) a degenerated form of the 

 yellow variety is occasionally found, in appearance not wholly unlike these black 

 masses, so that the relation between all these forms seems to be fully established." 



Boyce and Surveyor (1893 and 1894), in addition to a thorough discussion 

 of the etiology of the disease with special reference to the difference between the 

 two varieties, have given one of the most succinct and comprehensive general 

 descriptions of mycetoma which we have seen. Their description is so lucid and 

 brief that we quote from it as follows : 



"The Madura foot of India is a very chronic affection, lasting in some cases 

 twenty-five years. It is purely a local disease of the extremities, chiefly the 

 foot, and generalization has not been observed. It usually occurs in people 

 who go barefoot and are working in fields. In most cases it has been traced 

 to some injury. The big toe is often affected at first. The disease stops at 

 the ankle for a short time, then it spreads up to the knee, and eventually may 

 even reach the thigh. One of us has had the opportunity of seeing a recurrence 

 in the scar after amputation ; this, however, must be very rare, and amputation 

 affords complete relief * * * and is, indeed, one of the most successful 

 operations in India. The foot * * * is greatly altered; it is enlarged, 

 often many times the natural size. The overgrowth of the foot is irregular; 

 the toes may become buried, * * * and the surface becomes studded over 

 with mammillated, or even villous, projections. A large number of the mam- 

 millated projections mark the presence of sinuses, which pass deeply into the 

 foot ; and on section these may be seen to honeycomb it. From the opening of 

 the sinuses a purulent or sanguinous discharge can be pressed out, and in this 

 are found, in one series of eases, small particles of a light yellow color, which 

 have been compared to fish roe; while, in the remaining cases, deep brown or 

 black particles, resembling grains of gunpowder, may be seen. The disorganiza- 

 tion of the interior of the foot becomes very complete in time; the bones 

 undergo a rarefactive ostitis, and are ultimately absorbed, granulation tissue 

 also invades the muscles and fat, and lends to their disappearance. Associated 

 with the hypertrophy of the granulation tissue there may be considerable hyper- 

 plasia of the epithelium of the skin. This overgrowth gives rise to the mam- 

 millated ana papillomatous projections previously referred to. 



"The only difference which one at present finds, clinically and microscopically, 

 in the numerous cases of Madura foot is the difference in the size and color of 

 the particles. Carter termed that form of the disease in which the black particles 

 were present the "melanoid" variety, while under the "white" or "ochroid" were 

 grouped those cases in which the fish-roe like bodies were found. It will be 

 understood that only those cases of Madura disease in which the particles can be 

 demonstrated maeroscopically or microscopically will be admitted as genuine. 

 The disease appears to be confounded with scrofula and various forms of elephan- 

 tiasis, in the production of which probably other parasites play an important part." 



Boyce and Surveyor examined, in a most careful manner, tissues from six 

 cases of the melanoid and from fifteen of the oehroid variety of the infection. 

 In an addendum to their article, they mention having studied "a large number 



