2144 



MYCETOMA AND PARAMYCETOMA 



4. The Grain. — Situate in the cellular sheath there lies a more 

 or less distinctly or indistinctly striated body, of varying shape, 

 and often with irregular edges, which is the grain, and is composed 

 of the fungus and its surrounding matrix. 



Fibrous Sheath. — ^When the fibrous connective tissue forming 

 the matrix is examined, in the vicinity of a fungal mass, it will be 

 observed to show collections of cells at intervals. 



FiBROCELLULAR LAYERS. — These layers are composed of loose 

 fibrous tissue, holding in its meshes plasma cells, healthy and de- 

 generating polymorphonuclear cells, giant cells, and bloodvessels. 



With regard to the giant cells, they may be seen to contain fungal 

 masses, or these may be observed escaping therefrom, or the giant 

 cells may be remarked to be separated from the fungal mass by a 

 little distance and to be damaged, while polymorphonuclear cells 

 lie near the fungus, and the adjacent layers of the fibrocellular tissue 

 may be observed to be arranging themselves circularly so as to 

 circumscribe the new fungal growth, and so to commence the forma- 

 tion of a new fungal mass. 



When two fungal masses lie in close approximation to one another 

 without the intervention of dense fibrous tissue, it will be observed 

 that small areas of the fibrocellular layers adjoining the two masses 

 show signs of granular degeneration. 



Another interesting feature, but by no means confined to the 

 fungal masses, is the presence of cells containing one or several, 

 small or large, rounded eosinophile globules. These were called 

 fuchsin or Russell bodies by Kanthack, and botryomycotic bodies 

 by Archibald (191 1), who published some excellent illustrations 

 thereof in Plates XV. and XVI. of the medical volume of the Fourth 

 Report of the Khartoum Laboratories. They are a product of 

 the fungus, and are frequently seen in nocardial infections lying 

 in cells at a distance from the fungus, in which case they are a great 

 aid in diagnosis, as indicating the probable presence of a fungus 

 somewhere. They are also seen in masses cut longitudinally and 

 lying in lymph spaces. They have been recorded by all workers 

 at actinomycosis and maduromycosis since the days of Kanthack, 

 and appear to us to be probably the same material as that forming 

 the club-like dilatation of the extremities of the hyphae in N. bovis 

 and other nocardias, and that they may possibly be a protective 

 substance excreted by the fungus which only under certain con- 

 ditions consolidates into the eosinophile form and into the clubs 

 of certain species of nocardia. 



The Cellular Sheath. — All our observations tend to support 

 Brumpt's view that primarily the fungus is enclosed in a cell which 

 in the younger fungal areas near the older area is always multi- 

 nuclear. 



Further, in the present specimen, there can be no doubt that the 

 fungus is not destroyed by the giant cell, but, on the contrary, grows 

 and escapes therefrom and starts life as a little fungal mass of its 

 own, in which instance the polymorphonuclear leucocytes now 



