CHAPTER VI.

MYCETOMA, OR MADURA-FOOT.

A CURIOUS disease of not infrequent occurrence in the
Indian province of Scinde is one known as mycetoma,
Madura-foot, or pied de Mad^tra. It almost invariably
affects natives of the agriculturist class, and in most
cases begins in or is referred by the patient to the prick
of a thorn. It generally affects the foot, more rarely
the hand, and in one instance was seen by Boyce in the
shoulder and hip. It is more common in men than in
women, individuals between twenty and forty years of
age suffering most frequently, but persons of any age or
sex may suffer from the disease. It is insidious in its-
onset, as has been said, generally following a slight
injury, such as the prick of a thorn. No symptoms are
observed in what might be called an incubation stage of
a couple of weeks' duration, but after this time elapses a
nodular growth gradually forms, attaining in the course
of time the size of a marble. Its deep attachments are
indistinct and diffuse. The skiti becomes purplish,
thickened, indurated, and adherent. The points most
frequently invaded at the onset are the ball of the great
toe and the pads under the bases of the fingers and toes.
In the course of months, although progressing slowlyr
the lesions attain very perceptible size, distinct tumors
being present. Later, sometimes not until after a year
or two, the nodes begin to soften, break down, discharge
their purulent contents, and originate ulcers and com-
municating sinuses. The discharge at this stage is a
thin sero-pus, and is always mixed with a number of
fine round black or pink bodies, described, when black,
as resembling gunpowder ; when pink, as resembling

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