448 MUSGRAVE, CLEGG, AND POLK. 



INTRODUCTION. 



Before entering on a study of the etiology of mycetoma, it is necessary 

 to define the disease. This is exceedingly difficult, either from a 

 clinical or an etiologic standpoint. 



Formerly the diagnosis was based upon a clinical picture the essentials 

 of which were a chronically enlarged foot with sinusses from which were 

 discharged small granules of various colors and consistency, accompanied 

 by a peculiar, oily degeneration of the tissues. Further classification was 

 made principally upon the color of the granules; black, ochroid, white, 

 red and mixed varieties being recognized. However, when bacteriologie 

 studies began to show the multiplicity of the organisms concerned in the 

 production of Madura foot it became necessary either to consider it a 

 clinical entity of multiple etiology or to attempt an etiologic classification. 

 This was made still more imperative by the discovery that the organisms 

 causing this symptom complex were found . also producing lesions in 

 other parts of the body. A number of authors have continued to use a 

 clinical classification, while others have attempted to give one based 

 upon etiologic findings. The result is great confusion in the nomen- 

 clature of the disease. 



As a prerequisite to an etiologic classification and definition of myce- 

 toma it is necessary first to know and to be able to classify the etiologic 

 factors concerned. So far this has not been done satisfactorily. The 

 botanists are hopelessly confused in their grouping of the organisms and 

 in consequence medical men have been unable properly to identify them. 

 In the first place, authorities differ as to where the group of organisms 

 belongs in the vegetable kingdom, some placing it among the bacteria and 

 others higher up among the fungi. Practical^ all the latest writers 

 upon the subject agree' as to the great similarity between the various 

 species of these organisms and the majority have placed them as species 

 of a single genus, or as fiarts of two or even three closely allied genera. 

 In order to establish a uniform and clear conception, and after carefully 

 studying all phases of the question we have decided tentatively to accept 

 Streptothrix Cohn 1875 as the generic name of the group of organisms 

 under discussion. 



The result of this decision is that the other names given to the ten- 

 tative genus, such as Actinomyces, Nocardia, Oosperm, etc., become 

 synonyms, the disease streptothricosis being limited to infection with 

 parasites properly belonging to the genus, the various species of which 

 will be considered jiresently. 



Adopting such an interpretation, we have a fairly definite group of 

 organisms with reasonably uniform pathologic and clinical manifesta- 

 tions, connected with other groups of closely related organisms giving 

 somewhat similar manifestations. For example, the O'iclia or Blasto- 

 myces on the one hand and the tubercle bacilli on the other, may some- 





