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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    where the fungus-disease is common, and are stated to be due to pricks o£ thorns, &c., opinion maj fitly be guarded, until the proper contents of the swelling are ascertained. A finger or toe may alone be affected; and it is not uncommonly stated that the first sign is here a pimple or small, hard lump : I should say that the nearest approach to such mark would be made by a thorn or other foreign body lodging in the part; but probably there would then be a history to guide, and some remains of an opening, sufficient to eliminate error in diagnosis. I have thought that the tough, ligamentous structures here serve to check the fungus-growth, as long as it is confined to such segment of a limb. Indurations of the skin, or a deep-seated, indolent, ill-defined and hard tumour, may respectively, for a time, be mistaken for syphilitic or strumous deposit, or for incipient enchondroma, cancer, or other affection of the bones, &c.; but here again the sinuses and characteristic discharge therefrom, would sooner or later furnish adequate means of discri- mination. This remark is of general application : for diagnosis may proceed by exclusion, until it becomes possible to lay hold of positive characters; and in no disease affecting man, are the latter more eminently diagnostic than here. In all circumstances a combination of distinctive signs should be sought for; but first of all, I repeat, should the character of the discharge from the sinuses be carefully, and if a single result be negative, then repeatedly examined; a lens may be needed, and any suspicious-looking, granular particles being detected, they should be removed on the point of a scalpel or knife-blade, and transferred to a glass slide, gently washed with distilled water, and submitted to the scrutiny of the microscope. An object-glass of half-inch focus would always prove sufficient to bring out the characters of the ordinary fungus- particles ; but for the purpose of minute investigations, the highest available powers, and conjoined use of reagents, will be necessary. B. Advanced Stage.—Tumefaction of the foot, when of considerable size, might be confounded with Elephantiasis (Arabum) of the same part; but it is not of a puffy or oedematous character; it extends to the sole of the foot, or may be limited to one region only; it rarely passes above the ankle-joint; it is hard, nodulated and irregular; and is permeated by sinuses, whose apertures are peculiar, and discharge characteristic. The Elephantous swelling differs in all these particulars ; it may, indeed, be marked by minute vesicles, or weeping cracks and fissures in the skin, but these signs are altogether unhke the fistulous openings above referred to. The skin is thrown into broad and characteristic folds; and almost always the leg is implicated. There happens too, at times, fever with local exacerbation of the swelling; and, as well, implication of the lymphatic system, which is never affected in Mycetoma. ■ Sectional appearance of the fungus-foot, after amputation, may, in its non-vascular tint and evident thickening of the fibrous tissues, somewhat resemble Elephantiasis; but there the comparison ceases, for Mycetoma has additional characters altogether its own. In Caries the form of the swelling may at first be similar, but its mode of origin is different, its progress quicker, and its ultimate size and shape never equal to, or resembling, those of Mycetoma. The sinuses are less numerous, and characteristic particles are absent from the discharge : this is diagnostic. Marked local inflammation and pain precede the advent of abscess, and before long the constitution of the patient suff'ers; he cannot stir