﻿ETIOLOGY OF MYCETOMA. 497 



vei'y closely a tubercle in structure. The giant cells are often of large size and 

 may have a peripheral arrangement of their nuclei. They are a very prominent 

 element in the lesions. 



"The primary effect produced by the j>arasites upon the tissues seems to be the 

 development of nodules of epithelioid cells and of giant cells from the tissues im- 

 mediately about them. Later, suppurative processes occur in the nodules and 

 abscesses are formed, which in the tissue give rise to the development of granu- 

 lation and connective tissue in large amount." 



Unna and Delbanco's ( 1900) discussion of the subject is mentioned by MacLeod. 

 Brumpt (1901) reported a case of the black variety of mycetoma from Suakim, 

 Sudan. He gives tbe usual description of the granules. The grains are composed 

 of an enveloping membrane made up of mycelial filaments. The inner portion is 

 very friable and easily crushed. Cultures in hay infusion and bouillon gave neg- 

 ative resiilts. Fourlerton and Jones (1902) published an exhaustive article 

 dealing with the pathogenesis of the Streptothrix group in general; the authors 

 in discussing Mycetoma consider Streptothrix madurce Vincent as the cause of the 

 ochroid variety, and J. H. Wright's Streptothrix as that of the black type. 



Laveran 23 studied an anatomical specimen of the black variety sent to him by 

 Bouffard. He found and described a Streptothrix in the granules and named this 

 organ S. mycetomi. The author does not report any experiments in the culti- 

 vation of the fungus. 



Madden 2i published two cases of the pink variety of mycetoma occurring in the 

 Sudan. In one of the patients the primary lesion was in the thigh, and later 

 the disease involved the abdominal wall. Pinoy succeeded in one month in culti- 

 vating a Streptothrix in anaerobic, sweetened bouillon. With these cultures he 

 was able to infect a pigeon's foot. 



Scheube (1903) discusses the question of the identity of actinomycosis and 

 Madura foot as follows: 



"I need only recall the different size and coloring of the fungoid masses, in the 

 two diseases, their different localization, and the difference of their course, which 

 in Madura foot is more benign and more chronic than in actinomycosis. The 

 pronounced tendency also for actinomycosis to spread to other near or distant 

 parts of the body, to attack the internal organs, and the transmissibility of acti- 

 nomycosis to healthy persons, are qualities which, at least according to our present 

 knowledge, are not possessed by Madura foot. Moreover, the hyphomycetes of 

 Madura foot are more delicate, and stain remarkable well with hematoxylin, 

 showing the prisms and columns described above as staining with difficulty. 

 Actinomycosis, on the other hand, is not stainable with haematoxylin and develops 

 clubs and knobs which are difficult to stain." 



Manson (1906) in discussing S. madurce Vincent considers that "though 

 closely allied to the better known fungus (Actinomyces) , apparently it is not 

 specifically identical with it." 



Nicolle and Brunswic-LeBihan 25 report mycetoma in an Arabian woman. The 

 original lesion was produced by a barley spore introduced one year before the 

 mycetoma was established, and Nicolle and Pinoy - 6 report a case of the ochroid 

 variety of the disease in an Arab. They described and cultivated a Streptothrix 

 from the lesions. The organism was grown upon sweetened hay infusion and 

 developed on the surface of the medium as a light gray superstratum upon a 



23 Bui. Acad, de Med. (1902), (3), 47, 773. 

 21 J. Trop. Med. (1902), 5, 243. 

 -''Bui. Acad, de Med. (1906), (3), 55, 132. 

 20 Arch. d. Parasit. (1906), 10,437. 



