﻿500 MUSGEAVE AND CLEGG. 



sufficiently clear and which follow required methods closely enough to 

 be of value in a comparative stud)'. These are Vincent's report on &■ 

 madurce as the cause of the infection in the ochroid variety, and Wright's 

 article reporting a Hyphomyceie as the etiologic factor in the melanoid 

 type of the disease. The work of both these authors seems to have been 

 carefully carried out and their conclusions appear to be sound, but in 

 neither investigation did the authors establish the etiologic relation of 

 their organisms to Madura foot by experiments on animals. However, 

 leaving this omission out of consideration and studying the cultural 

 characteristics of their fungi alone, the evidence seems to be conclusive 

 that S. freeri differs from both of their organisms. This is not only so, 

 but when we compare its characteristics with the description of other 

 species of pathogenic Strepiothrix which have been cultivated by others, 

 we find our organism clearly to be distinct. The table opposite gives 

 . a comparative summary of the characteristics of six of these Streptothrices, 

 and it includes those of S. actinomyces. 



There can be no reasonable doubt but that all types of mycetoma 

 are due to Strepiothrix infections, but whether all the forms are caused 

 by an infection with a uniform organism or whether more than one 

 species plays a part in the disease, can not now positively be stated. 

 However, it is very probable that Madura foot may be produced by any 

 one of several species of Steptothrix, and that lesions of etiology identical 

 with the ones occurring in the foot may be produced in various parts 

 of the body. Such infections are now occasionally recognized. It seems 

 likely that some of these lesions, located in places other than the foot, 

 are not considered to be mycetoma, more because of their location than 

 because of any specific differences in the parasites. However, if the 

 methods employed by observers who have reported mycetoma in parts 

 of the body other than the foot are examined, it is certain that the 

 diagnoses of these infections were based upon morphologic considerations 

 of the Streptothrix as a whole, and therefore were not conclusive as 

 to the determination of species. 



S. freeri is as pathogenic for monkeys, when it is inoculated in the 

 deep tissues in other parts of the body, as it is when injected into the 

 foot, where it produces typical mycetoma clinically and pathologically. 

 It seems probable that mycetoma most often occurs in the foot because 

 of the accidents to which that member is exposed and in this connection 

 it may be stated that the right foot is more frequently affected than the 

 left one. If the general infections produced in animals by S. freeri 

 prove to be experimentally practical with other types of the disease, 

 then Madura foot becomes a variety of streptothricosis differing from 

 other types more in anatomical position than in specific etiologic 

 distinctions. 



The review of the literature Avhich has been given shows that there 

 is much difference of opinion in regard to the etiology of Madura foot. 



