2Il8 



MYCETOMA AND PARAMYCETOMA 



broth, small white colonies composed of radiating threads were found 

 sticking to the walls of the tube. No diffuse growth was seen, nor did 

 any scum form on the surface. Animal experiments were negative. 



Mackenzie, in the same year, appeared to obtain similar cultures 

 on agar; at first the growth was white and translucent, with radia- 

 tions from the centre, later it became greyish yellow, there being a 

 central granule surrounded by a clear zone and an indented margin. 

 After a week the colony became a deep mahogany, and under the 

 microscope exhibited mycelial structures. 



Semon (1915) reported a case of black maduromycosis which 

 occurred in a native Indian soldier serving in France. He left 

 India about October, 19 14, and in January, 19 15, he injured one of 

 his feet by the fall of an ammunition box. The patient attributed 

 the disease to this cause, but Semon considers, probably correctly, 

 that he must have been infected before leaving India. A typical 

 mycetoma developed in about six months, and the pus contained 

 black particles in which a central mass of mycelium obscured entirely 

 by black pigment could be made out, but no proper demonstration 

 of the fungus in situ could be made. The foot could not be ampu- 

 tated, but sections were made of some of the tissue, which showed 

 marked vascular hypertrophy, polymorphonuclear, plasma, and 

 connective tissue cells, but no endo- or periarteritis and no giant 

 cells. Growths were obtained at 35° C. on agar-agar, maltose agar, 

 and Raulin's fluid. The fungus formed a central black portion with 

 a peripheral zone of white or grey, and in the course of ten days or 

 less became black. 



In 1916 Chalmers and Archibald grew a fungus allied to that 

 described by Semon from a case of black maduromycosis found in 

 the Anglo-Egyptian Sudan, and in 1918 defined and classified the 

 Maduromycoses. 



Climatology. — The Maduromycoses are known to occur in Europe, 

 Africa, Asia, and America, but not in Oceania. 



The climatology has been most thoroughly studied for black 

 maduromycosis, which occurs in the Anglo-Egyptian Sudan, where 

 the disease was first described by Balfour in 1904, and the northern 

 part of which is hot and arid. He gives the native name for myce- 

 toma as ' Napt Hindi Nabit,' and states that the black variety is 

 most frequently encountered, and that the foot is the part principally 

 affected, while the inguinal glands are often involved. In 1908, 

 Wenyon noted its presence at Bor, which is hot but not arid, while 

 Balfour's researches in 191 1 have already been noted in the historical 

 section. According to our inquiries, the word most commonly used 

 by natives in the Sudan is ' en-nabt,' which means ' the growth.' 



In addition to the Anglo-Egyptian Sudan, the following is a 

 list of African places from which cases of black maduromycosis 

 have been reported: — Algeria, Tunisia, Somaliland, Madagascar, 

 Transkei (South Africa), Senegal, and the French Sudan. 



In Asia the disease is recorded from the Yemen, various parts of 

 India, Ceylon, and possibly from North Borneo. 



