2124 



MYCETOMA AND PARAMYCETOMA 



later, breaking free from the main mass, form means of asexually 

 propagating the fungus in the foot. Some of these separated clubs 

 are attacked and engulfed by leucocytes, and though it is possible 

 that in this way many may be destroyed, still, Brumpt's researches 

 show that the leucocyte, with its enclosed club, may wander away 

 from the diseased area into healthy tissue, and may be killed by the 

 club, which, being set free, grows into a new mass of fungus. In 

 this way the fungus may be disseminated by means of the phago- 

 cytes. 



When surrounded by pus, the fungus gathers itself into granules, 

 the so-called sclerotia, which show externally radially arranged 

 fibres or clubs, and internally a mass of mycelium with crystals and 

 debris, the latter being most marked in the centre. These granules 

 escape to the exterior, and form the yellow, black, or pink granules 

 in the discharge. As the fungus grows in the foot the connective 

 tissues and the muscles undergo vitreous degeneration, and break 

 up into debris, amongst which pieces of nerves and tendons may be 

 found, while even the bone in some cases becomes attacked by a 

 form of degeneration and disappears. The result is that the foot 

 appears much swollen externally, and shows the openings of the 

 sinuses, through which the pus and the fungoid granules escape; 

 while internally the normal structure may have completely dis- 

 appeared, being replaced by degenerated tissue, debris, sinuses, 

 and fibrous sacs containing the fungus and the pus. 



The result is, however, not merely destruction of the foot, but 

 also great bodily waste, due to the continuous discharge, so that 

 the patient becomes emaciated, and may finally die of cachexia. 



Morbid Anatomy. — The pathological anatomy of black maduro- 

 mycosis has been the subject of a fair amount of investigation. 

 Kanthack merely drew attention to the fact that the black masses 

 were always to be found embedded in dense fibrous tissue, while a 

 few pus and granulation cells were to be seen in most cases. In the 

 fibrous wall yellowish-brown or black pigment could be found, 

 while fuchsin bodies were present in most specimens. Unna's 

 example, obtained from Kanthack, only showed fibrous and some 

 granulation tissue. Boyce and Surveyor drew attention to the 

 presence of small round cells, macrocytes, and giant cells surrounding 

 the fungus in cases of black maduromycosis. Their microphoto- 

 graphs are, however, mainly devoted to the fungus, while their 

 Fig. 22 evidently depicts a very young piece of fungus surrounded 

 by giant cells. 



Wright (1898) stated that the nodules consisted of more or less 

 atypical connective tissue, in the cavities of which the granules lay 

 surrounded by polymorphonuclear leucocytes, loose epithelioid cells, 

 and cellular detritus. The cavities were lined by either a wall of 

 vascular granulation tissue or by masses of epithelioid and multi- 

 nucleated giant cells, while these cells closely invested other granules, 

 and outside of this tissue lay lymphoid and plasma cells. He gives 

 in his original paper four excellentj^low-power photographs, of which 



