On mycetoma, or, The fungus disease of India / by H. Vandyke Carter.

Date:
1874
Catalogue details

Licence: Public Domain Mark

Credit: On mycetoma, or, The fungus disease of India / by H. Vandyke Carter. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    The minute structure of tlie fungus will be described further on. A portion of the foot is preserved in the Grant College, Bombay, and one half was sent to England for exhibition to the Pathological Society of London, in May, 1860. This specimen is now preserved in the Museum belonging to the Army Medical School, at Netley.i Case 3.—A third example was forwarded to the G-rant College by Dr Asher, Civil Surgeon at Hydrabad in Sind, with the following memoranda'^ :— Foot (right) of a prisoner in Hydrabad jail, amputated Slst October, 1860. Disease commenced in the sole of the foot by the appearance of a tubular (?) indolent swelling, at the end of 1856, attributable to no known cause. He previously enjoyed good health. Similar swellings gradually extended over the whole foot, and here and there circumscribed suppurations took place, giving rise to breaches of surface: and these, remaining open, took on the appearance of papillfe from which there came a scanty thin discharge. A deep aching in the foot was merely felt, there being no acute pain at any period of the disease. Progression up to the date of amputation was merely incommoded by the weight of the foot, and for a consider- able time previous to the operation, the man was in weak health and much emaciated : he was born and resident all his life in the neighbourhood of Kotri, being occasionally employed in agriculture, but for the most part as a musician. Description of the specimen.—General external form of foot striking and characteristic: the swelling, of con- siderable size, involved the whole member, and is particularly large about the ankle-joint; the toes are free. Numerous apertures are scattered over the surface, several being on the sole of the foot; they have the usual pouting appearance. Section :—The small hones and soft parts are indistinct on account of the growth of a dark-coloured glairy substance, imbedded in which are the black fungi: tibia,—in the cancellous tissue of its lower extremity are one or more collections of black particles; in the os calcis are others: there being the usual spherical cavities in these bones, as well as in others that are affected. The amount of parasitic development is very considerable, and was, I think, rapidly increasing at the time of amputation. As regards the minute struc- ture of the fungus in this case, it corresponds whoUy with that previously observed : but this specimen will be again referred to as one demonstrating the way in which the melanotic form of fungus seems to commence {see Plate VIII, fig. 2). Case 4.—A Hindoo (male), set. 30, a carpenter from the Deccan (near Nassick) : the left foot is affected characteristically, and to a considerable extent: the disease began one year since with an abscess in the sole, during the cold season. Health reduced: the foot is painful. Amputation was performed at the J. J. Hospital Bombay, on September 26th, 1861; and the man was discharged cured at the end of October. In general form and appearance this specimen resembles others previously described; The tarsus is chiefly affected: the toes are free. Numerous sinuses open on the dorsum and side of the foot, and a large cluster of openings is seen in the middle of the sole : most of them discharge a thin purulent fluid, and in some of them small black particles may be seen : these are the fungi, and their nature was clearly made out before operation. A section of the foot was made immediately after removal and the appearances preserved in a sketch {see fig. 2, Plate II). The black masses and granules located in the spherical cavities and tubular canals were imbedded in a whitish, semi-opaque, glairy substance of homogeneous consistence ; the walls of the canals were thin, had an opaque yellow colour, and were readily torn. The soft parts around them were converted into a gelatiniform substance which takes the place of the degenerated muscles, &c.; the tendinous and fatty structures are less altered. Microscopic examinations of these parts were made, and the results wiU be afterwards referred to: Chapter I, Section V. ' The same Museum also contains an entire foot affected with the Ochroid variety of Mycetoma, and both examples were selected (with others of different diseases) by me, during the period I was Curator of the Museum at Grant College, in Bombay. 2 Other notes of Dr Asher are these :— The produce of his native district consists of grain and cotton, but in the culture of the former alone has he been engaged. The small tract of country to which his residence has been confined lies along the right bank of the Indus, and the soil is light clay. Has never known any other person suffer from the disease under which he labours, but has heard of it from others, and believes it is called in the vernacular ' Nagro'; a term, however, which seems not familiar to many, and apparently not confined to this particular disease. The natives have here no superstitious views as to its cause, nature, or cure; they regard it as incurable, &c., said never to be known in any other part but the foot; and in the subjects of it no hereditary tendency or particular diathesis can be traced. Within the last few days, since writing the above, another in- stance, altogether similar, has occurred in my practice.