340 REPORT OF THE HARVARD AFRICAN EXPEDITION 
swollen and deformed in such a way as roughly to resemble an irregularly- 
shaped potato (Nos. 262-263). The great toe was represented by a knob project- 
ing upward. There was practically no evidence of the existence of other toes, 
they having disappeared in the swollen mass. The stump of the foot consisted 
of rather hard tissue, the skin firmly adherent to the surface, generally smooth 
except for the presence of two superficial excoriations, about 3 to 4 centimeters 
in diameter. These were apparently covered with sawdust. Some soft black 
substance had also been applied over nearly the whole surface of the skin of the 
foot. There were several superficial scars on the mass which were pink in color. 
In the photograph two superficial scars may be seen just above the left ankle. 
In these there was moderate deficiency of pigment. The legs appeared con- 
stricted at the ankle, owing particularly to the swelling of the foot. 
Nothing definite regarding the history of the pathological condition could be 
obtained except that it had existed for a long time. It obviously is of a chronic 
nature. Examination of other parts of the body showed that the right tibia 
bulged somewhat anteriorly. The metacarpals of the right hand also seemed 
slightly curved and bent, and the motility of the hand somewhat diminished. 
Besides the sears already referred to on the left foot and ankle, there were 
irregularly-shaped superficial scars on the inner aspects of the thighs, left lower 
leg, forearms, anterior surface of the right elbow, the back of the hands, and on 
the cheeks. 
The pathological condition resembles madura foot only to some extent in its 
size and shape. In mycetoma the toes are usually more or less preserved and 
generally but little affected. In the present instance, moreover, no nodular 
lesions were present and no openings or sinuses were apparent, as are usually 
noted in mycetoma. In microscopical examination, no mycetoma granules 
were found, and no acid-fast micro-organisms. 
To judge from the photographs published, a condition which to some extent 
resembles the one described here is that reported as occurring in Netherlands- 
India by Ten Brink ! as sporotrichial in character. Apparently, however, from 
his description ulcerations were present, though these cannot be distinguished 
in the photograph in his article. The nature of the infecting micro-organism 
and the histological conditions are not described. 
Five pieces of tissue were removed from the lesion of our case for histological 
examination, the tissues being placed in Zenker’s solution at the time of removal. 
Some of these pieces of tissue were hard and fibrous-like in consistency, while 
others were much softer. Eight film preparations were made with material ob- 
tained from the cut section of the moist tissues from the different portions of the 
lesion; these were later stained in Giemsa’s solution and by carbolfuchsin and 
Ziehl-Neelsen-Gabbett’s method. On microscopical examination very numerous 
round and oval mycotic forms both free and enclosed in epithelial cells were 
found. Occasionally they were seen within endothelial leucocytes. Other slides 
showed enormous numbers of small cocci and smaller numbers of bacilli, the 
latter however were plentiful. Large coccoid forms occurring singly, more fre- 
1 Ten Brink: Gen. Tijdschr. Nederl. Indie, Deel 56, Nr. 2, S. 178. 
