MYCETOMA AND PARAMYCETOMA 



condition, known to the natives by the names ' roaki,' ' buno,' or 



' auma/ which he considers is a separate chnical entity from yaws. 



He says that the foot closely resembles Madura foot, without the 



presence of the typical grains in the pus. 



A similar condition is known to occur in sporotrichosis. The 

 foot in this case is swollen and painful, and shows subcutaneous and 

 deep gumma-like swellings. Fistulae discharging pus are also present. 



A similar condition has been described by Austregesilo as being 

 due to an angiokeratoma in the foot of a negro in Brazil. The 

 foot was much enlarged, with several nodules, from which white 

 material exuded. Microscopical sections enabled a correct diagnosis 

 to be made. The whole condition, however, resembled a mycetoma, 

 but neither grains nor fungal hyphae could be found. His paper 

 contains an excellent illustration. 



ACTINOMYCOSIS OF THE BODY. 



Remarks. — The fungi producing Madura foot may occasionally invade other 

 parts of the body instead of, or in addition to, the foot. They may attack the 

 skin and deeper tissues of the hands, trunk, mammae in females, and also the 

 deep organs, lungs, heart, liver, brain. For such conditions the term ' myce- 

 tomiasis ' may be used, and when the fungi found are Nocardia hovis and 

 Nocardia Israeli , the term ' actinomycosis ' is generally employed. These two 

 fungi, in fact, seldom attack the foot. Some authorities used the term ' pseudo- 

 actinomycosis ' to indicate the condition induced by Nocardia ponceti Verdun, 

 1912, N. liquefaciens Hesse, 1892, N.garieni Brumpt, 1910. 



Symptomatology. — The lesions resemble, to a certain extent, those found 

 in the foot. The condition generally begins with indolent nodules in the 

 skin or subcutaneous tissues; the skin over them becomes tense and glossy, 

 and finally the nodules break down, with formation of sinuses, from which a 

 purulent liquid exudes, containing the characteristic granules, of various 

 sizes and colour, as described in Madura foot. Occasionally the ulcerated 

 lesions become fungoid and large, and papillomatous purplish tumours may 

 develop. The location of the lesions varies. The type caused by Nocardia 

 Israeli Kruse and N. hovis Herz, or true actinomycosis, as found also fairly 

 frequently in temperate zones, is in most vases situated on the lower region 

 of the face and neck, especially in the tissues under the jaw. In cattle it 

 produces the well-known condition known as wooden tongue. It is charac- 

 terized by the presence of sulphur-yellow grains in the pus. Of actinomycosis, 

 besides the cervico-facial situation, which is the commonest, the following 

 types have been described : The parietal, attacking the walls of the thorax and 

 abdomen; the broncho-pulmonary; the abdominal (liver, etc.); the cerebral 

 (very rare), in addition to the rare type situated on the foot (actinomycotic 

 mycetoma) . 



Prognosis. — This depends greatly on the species of fungus causing the 

 malady. The types due to Nocardia hovis, Nocardia Israeli, or true actino- 

 mycosis, ariswer well to a potassium iodide treatment. 



Diagnosis. — This is based on the presence of indolent or nodular masses, 

 breaking down with formation of pus, in which grains containing the fungi 

 are found. 



Treatment. — Potassium iodide in full doses (gr. xx.) three or four times a day 

 should always be administered. 



Nodular Actinomycosis of Pinoy and Ravaut. 

 Historical and Geographical. — This condition and its fungus were studied 

 by Pinoy andjRavaut in France. 



iEtiology.— The condition is caused by a Cohnistreptothrix. Only one case is 



