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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    non-existence is therefore implied by tlie absence of any reference to tliem in the above account. c. Changes produced in the Bones.—These have been referred to by many early writers, but have not, so far as I know, been fully described. All the macerated speci- mens I have seen, are strikingly different from others of diseased bone; and the changes which they present would almost lead to the conclusion, independently of other con- siderations, that some organic agency had been in operation. The cancellated tissue of the long- bones of the leg, and of any or all of the bones of the foot, is the seat of cavities more or less spherical in shape, and sometimes most per- fectly so, which vary in diameter from one fifth to two thirds of an inch ; and which have for their walls the open cancelli. These cavities, when in close juxta-position, frequently open into each other, thus producing larger vaulted gaps or spaces ; and not only so, but every cavity, large or small, has a free communication, direct or indirect, with the external surface. When superficially placed, some of their parietes being formed by soft parts, the excavations in the bones look like mere round holes of various depths ; but when deeper situated, a regular tunnel, more generally straight than curved, serves as the channel of communication with the exterior; and the diameter of these passages varies, being some- times equal to that of the cavities themselves. In the recent state the sinuses of the soft parts, where they do not end in the superficial collections of fungi, lead down to these tunnelled passages, or into the rounded holes formed in the bones. These cavities appear to be a main seat of fungus growth, and their form would then be readily understood from the disposition which the fungus possesses (as was clearly seen in examples of the dark variety of Mycetoma) to acquire a globular shape, and hence to pro- duce a corresponding excavation, doubtless brought about by pressure, in the tissues hard and soft; even in the more common variety of the disease, be that another stage or not of the first, the pale, soft granules may be seen to be aggregated in many cases into globular mulberry-hke masses lodged in similar cavities. The osseous tissue seems to be generally healthy in texture, and only acted upon by the mere pressure of these new growths; or a little rarefied, as if from increased vascularity. Sometimes, however (as stated in Case 2, p. 4), softened spots, apparently unconnected with the presence of a fungus mass, are found, which may assume a spherical form on drying; in the case just referred to these cavities are best seen in the tihia, and they have connected with them small tunnelled passages leading to the exterior, yet not a particle of pus, or anything like strumous deposit, was contained in the cavities, and there appeared to be only an accumulation of fatty matter; but it is probable that fungi had been there, subsequently being expelled, or having undergone a fatty change. In no other instance were seen either caries or soften- ing of the bones, either independent of or in connection with the characteristic cavities ; and commonly the latter alone are present, without attendant complications of any kind.^ 1 I was informed by Surgeon Stedman, late Civil Surgeon at Hyderabad (1859), that be had there seen a case which was probably one of the first variety of this disease, black masses and tunnelling of the bones being present, but there was also softening of the cancellous tissue, in parts. It should be remembered, I think, that this may occur from either thinning (as produced by mere pressure), or from simple wasting, without there necessarily being any morbid deposit in the cancelli, or their lining membrane. In either case the caneelU either remain of their normal size (as occurs in Mycetoma), or, if they be expanded, other very manifest signs of iacreased vascularity, as enlarged vascular apertures, roughening of the surface, &c., would be readily apparent. In Cancer or Struma there is a visible deposit or fleshy growth, and the bones are affected very variously in mode and degree. It may be thought that circumscribed abscess of bone might simulate the appearances above