^146 MYCETOMA AND PARAMYCETOMA 



• (a) Peculiar eosinophile bodies. , - 



(b) Fungal filaments. . , , . ^ 



(c) Minute grains. 



{d) Cultures and animal experiments. 

 {e) Minor points. 



{a) Peculiar Eosinophile Bodies.— These are single bodies 

 enclosed in cells, or several large and apparently free bodies. 



In our opinion these bodies are composed of a chemical substance, 

 apparently formed in human tissues by several different kinds of 

 fungi, but more particularly by the nocardias. The substance may 

 be noted lying in a lymphatic, or in the form of these bodies in cells 

 at a considerable distance from the site of the fungus. Hence 

 their importance in diagnosis and the necessity on discovering them 

 for further search in the tissues, or the patient, for a fungus. 



(5) Fungus Filaments. — -The most common filament to be 

 found in a paramycetoma is the nocardial hypha. These are easy 

 of recognition to the trained eye, but are apt to be mistaken by 

 persons not acquainted with mycology and to be recognized as 

 bacilli, while their spores, if present, may be considered to be 

 micrococci. 



Other forms of fungi, however, may cause a paramycetoma— 

 e.g., fungi of the type of a leptothrix. 



It will thus be seen that just as we divided the mycetomas into 

 the actinomycoses and the maduromycoses, so can the paramyce- 

 tomas be divided by the nature of the hyphal filaments into the 

 paractinomycoses and paramaduromycoses. 



(c) Minute Grains.- — -These grains are very minute in size, and 

 very few in number, and, in our experience, are most difficult to 

 find, and, indeed, are perhaps often absent when the case may be 

 due entirely to hyphal filaments not collected into grains. 



(d) Cultures and Animal Experiments. — We have been un- 

 fortunate with our attempts at cultivation and in our animal inocu- 

 lations, but the success attained by the Leytons indicates that these 

 can be done at all events with certain species of fungi. Our climatic 

 difficulties must be remembered in connection with our failures. 



(e) Minor Points. — -Among minor points which are worth noting 

 are the presence of many plasma cells either in good condition or 

 degenerated. 



The condition of the vessels, which often show endarteritis or 

 periarteritis, just as in mycetoma, is also worthy of note. 



Another minor point is a peculiar glassy or vitreous macroscopical 

 appearance, which is due to a degeneration of the tissues of a glassy 

 nature, and must not be mistaken for hyahne degeneration. 



For certain diagnosis the fungal filament should be found, but, 

 failing this, the eosinophile body is of the utmost importance. 

 These bodies, if associated with many plasma cells, degenerated 

 plasma cells, and changes in the bloodvessels and glassy degenera- 

 tion, are aknost pathognomonic of the presence somewhere of a 

 parasitic fungus. 



