2II2 



MYCETOMA AND PARAMYCETOMA 



disease was commonly known in some parts of India as ' Madura 

 foot.' As no mention is made, as far as we know, by these authors 

 of any black pigment being present in their cases, we conclude that 

 probably they saw the actinomycotic variety of mycetoma, 

 f^llt is interesting to note that about this time (1845) von Langen- 

 beck, in Kiel, made illustrations of some curious bodies which he 

 considered to be fungal in nature, and which he found in the pus 

 from a case *of spinal caries. Unfortunately he never published 

 this observation, which was made known by Israel one year after 

 Bollinger's discovery, which will be mentioned below. 



In 1848, Lebert found some peculiar spherical yellowish bodies, 

 about the size of a pin's head, in some thick gelatinous pus which 

 Louis had obtained from an abscess associated with much swelling 

 of the thoracic wall in a man, aged fifty years, in Paris. These 

 bodies were carefully examined,both microscopically and chemically, 

 and drawings were made which were subsequently published by 

 Lebert (1857). 



We have examined copies of these drawings, and they represent 

 in a typical manner the fungus of an actinomycosis. Lebert, 

 however, failed to recognize their fungal nature. 



In 1855, Smith, in London, made some drawings for Paget of 

 a tumour of the upper jaw, in which an organism resembling a 

 ray fungus is portrayed. These drawings were published by 

 Kanthack (1896). 



Also in 1855, Ballingall, in India, described a disease of the 

 foot, in the discharge from which he found bodies composed of large 

 cells with transparent fringes containing irregular spicules, or 

 simply" composed of radiating spicules without cells. In 1858, 

 Rustomji described a variety of Madura foot in which he found small, 

 soft, yellowish granules, and which he distinguished from another 

 variety of the same disease, in which he found a dark, soft, thick 

 substance. Rustomji's first variety we call yellow actinomycosis 

 and his second variety black maduromycosis. 



We will now consider the subject of the Maduromycoses. 



THE MADUROMYCOSES. 



Definition. — The Maduromycoses are those forms of mycetoma 

 which possess grains composed of large segmented mycelial filaments, 

 possessing well-defined walls and usually chlamydospores. 



History. — Excluding some ancient references discovered by 

 Collas, to which Corre has drawn attention, and which will be con- 

 sidered when we discuss that author's writings, the history of the 

 black maduromycoses commences in 1845 in India, where Garrison- 

 Surgeon Godfrey, in his Departmental Report of the Public Dis- 

 pensary at Bellary, described the occurrence of a considerable 

 black deposit, much resembling fragments of coal, in a foot which 

 had been amputated because it was affected by a disease which was 

 ' commonly known as ' ulcus grave,' because the ulcers and sinuses 



