THE MADUROMYCOSES 



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Figs. 4, 5, and 6, though older, if examined with a lens, will be 

 seen to agree more or less with Boyce and Surveyor's Fig. 22. 



Oppenheim's description in 1904 mainly deals with the fungus, 

 but Brumpt's account of the histological changes induced by 

 Aspergillus bouffardi covers all the important points — viz., the 

 polymorphonuclear leucocytes, the lymphocytes, the giant and 

 epithelioid cells, the connective tissue, the cells containing brown 

 pigment, and the endarteritis. On Plate XIX., Fig. 7, and Plate XX., 

 Figs. I and 2, he shows appearances resembling those described by 

 Boyce, Surveyor, and Wright in a young grain in which the giant 

 cells are situate close to the fungus. 



Boccaro, writing in 1909 in general terms for the encapsulated 

 form of both white and black mycetomas, says: — 



' The fungal hyphae are surrounded by round cells, held together by a delicate 

 network of fine bloodvessels, the cells being located in the meshes of a fibrillar, 

 transparent, reticulated substance. On the inner side of the group of round 

 cells, between them and the central hyphal mass, is a collection of finely 

 granulated debris, and on the outer side, in most preparations, may be seen 

 large nucleated cells, giant cells, and phagocytes.' 



This description, which unfortunately is not illustrated, agrees 

 well with our observations. 



Balfour, in 191 1, published photomicrographs of black maduro- 

 mycoses believed to be due to Madurella mycetomi and to Aspergillus 

 bouffardi, but did not describe them. 



Babes (1913) gave a well- illustrated account of Indian black 

 maduromycosis, in which he observed far less cells than we have 

 noticed in immediate relationship to the fungus, from which the 

 giant cells were separated by fibrous connective tissue. He drew 

 attention to violet and reddish rounded bodies enclosed in cells. 



In 1916 Chahners and Archibald gave an account of the histology 

 of a case of black maduromycosis, and this is followed in the 

 description given below. 



Fig. 845 shows the general appearance of black maduromycosis 

 very slightly magnified. It will be observed to be largely composed 

 of fibrous tissue containing black particles 

 — the grains — and some spaces, which are ^^mtj ' ' ■ 

 formed by the falling out of some of the '^w*'^" ' 

 black granules during preparation. The W ^ ' 

 spaces demonstrate the character of the g 

 lacunae occupied by the grains and their black mIduromycosis. 

 surrounding cells. 



The fungal mass lies embedded in cellular tissue, as is shown in 

 Fig. 846. The spaces are artefacts produced in making the section, 

 which otherwise is as natural as possible — i.e., is not bleached or 

 softened in any way. The cracks in the black mass are also arte- 

 facts. Around the fungus lies a mass of small cells, and on the 

 upper and left side of the grain are seen some giant cells, which 

 also occur in other parts, but are not in such close relationship to the 

 fungus; then comes some fibrous tissue containing a number of 



