MADURA DISEASE. 297 



these methods, but in the case of sections of the tissues Gram's 

 method, or a modification of it, should be used to show the 

 filaments, etc., a watery solution of rubin being afterwards used 

 to stain the clubs. By this method, very striking preparations 

 may be obtained. 



To obtain cultures, tubes of one per cent glucose broth 

 whose reaction is 1.5 per cent acid to phenol-phthaleine, and tubes 

 of glycerin agar of similar reaction, should be inoculated with 

 portions of the colonies and incubated, anaerobically as well as 

 aerobically, at 37° C. Owing to the slow growth of the actino- 

 myces, however, the obtaining of pure cultures is difficult, unless 

 the pus is free from contamination with other organisms. 



Madura Disease. 



Madura disease, or mycetoma, resembles actinomycosis both 

 as regards the general characters of the lesions and the occur- 

 rence of the parasite in the form of colonies or " granules." 

 There is no doubt, however, that the two conditions are dis- 

 tinct, and it also appears established that the two varieties of 

 Madura disease {vide infra) are produced by different organisms. 

 This disease is comparatively common in India and in various 

 other parts of the tropics : it has also been met with in Algiers 

 and in America. Madura disease differs from actinomyces not 

 only in its geographical distribution, but also in its clinical char- 

 acters. Its course, for example, is of an extremely chronic 

 nature, and though the local disease is incurable except by 

 operation, the parasite never produces secondary lesions in 

 internal organs. Vincent also found that iodide of potassium, 

 which has a high value as a therapeutic agent in many cases 

 of actinomycosis, had no effect in the case of Madura disease 

 studied by him. It most frequently affects the foot; hence the 

 disease is often spoken of as " Madura foot." The hand is 

 rarely affected. In the parts affected there is a slow growth 

 of granulation tissue which has an irregularly nodular character, 

 and in the centre of the nodules there occurs purulent softening 

 which is often followed by the formation Of fistulous openings 

 and ulcers. There are great enlargement and distortion of the 

 part and frequently caries and necrosis of the bones. Within 

 the softened cavities and also in the spaces between the fibrous 

 tissue, small rounded bodies or granules, bearing a certain 



