﻿ETIOLOGY OP MYCETOMA. 499 



A very recent article by MacLeod 3 " discusses the etiology of the disease in 

 the following manner: "It is caused by the presence in the skin and underlying 

 tissues of a Streptothrix closely allied to, but differing from, actinomycosis. 

 The name Streptothrix madurce has been given it by Vincent. This fungus 

 forms the 'fish roe' like granules of the white variety, which is the common 

 form of the disease." The author in describing the nature of the black variety 

 states that there is a considerable variance of opinion, but he does not adhere 

 to the belief that its fungus is a degenerative condition of the infection produced 

 by the white type, but rather that it is a different species, as is claimed by 

 several writers. MacLeod also recognized a red variety of the mycetoma in 

 addition to the ochroid and melanoid types. In considering the differential 

 diagnosis of the disease from actinomycosis the author states: "Actinomycosis 

 is a disease which is transmitted from animals to man, and can be inoculated 

 in animals; it occurs in temperate latitudes, often runs a rapid course, affects 

 internal organs and mucous membranes, and has yellow granules in its dis- 

 charges; Madura foot is confined to man, has not been successfully inoculated 

 in lower animals, occurs in the tropics, runs a slow course, does not become 

 generalized, and presents granules of various colors." 



Caminiti 31 (1907) reports a new Streptothrix and discusses very fully the 

 whole group of Streptothrix; however, but little attention is given to mycetoma. 



DISCUSSIONS AND CONCLUSIONS. 



The study of our case of Madura foot, a report of which is giveu 

 in the first part of this paper, after a careful review of the literature, 

 establishes for the first time definitely so far as we have been able 

 to determine, the etiology of mycetoma according to the usual re- 

 quirements of investigators, including the transmission of the disease 

 by animal experiment. The causative organism we have determined to 

 be a Streptothrix, and as it apparently differs from previously described 

 fungi of the same genus we have named it Streptothrix freeri. We 

 believe this investigation fully establishes the etiologic importance of 

 S. freeri in one case of the pale or ochroid variety of Madura foot, but 

 nevertheless we are of the opinion that it does not finally settle the 

 entire question of the etiology of the disease. Some of the most im- 

 portant questions open for discussion are as follows : 



1. Is S. freeri sufficiently different from previously described organ- 

 isms to entitle it to be classified as a new species? 



2. Is mycetoma a distinct disease etiologically, or is it one type of 

 manifestation of more than one species of Streptothrix infection? 



3. Are the "ochroid" and "melanoid" varieties different stages of a 

 single etiologic entity, or are they due to different species of Streptothrix ? 



4. What is the relation of mycetoma to actinomycosis? 



In spite of all of the admirable older investigations on the subject 

 and giving all clue credit to the writers of former contributions, there 

 are but two articles dealing with the etiology of the disease which are 



30 Albutts' System of Medicine (1907), 2, 754. 

 n CentrM. f. BaMeriol. Orig. (1907), 44, 193. 



