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

  • Henry Vandyke Carter
Date:
1874
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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 Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    a distinct tumour. lu tlie case of tlie hlach variety there are large accumulations in the areolar tissue; and connected through them, or more directly with the surface, are similar accumulations within the substance of the deeper hard and soft tissue of the foot. In the first specimen^ which I examined (Plate I), it was found that the cavities containing the black, spherical masses (which may in the interior parts attain a diameter of upwards of half an inch), are well defined and lined by a distinct, though thin membrane; they all intercommunicate, or are connected with the free surface, by means of tunnels or canals (whose lumen may equal that of a small quill), also lined with a continuation of the same membrane, and passing outwards in a more or less direct course, to terminate at the orifices on the skin before mentioned. A probe directed down a sinus may or may not, according to circumstances, reach bone. The attendant “ elephantoid ” swelling was in this case but very slight; and the fungus-growth, contrary to usual, formed the mass of the swelling. Respecting the pale variety of the disease, in every instance which I have seen it was possible, on careful dissection, to make out a similar arrangement of parts. The new growth is here of a pink, orange, or buff colour, of small size, and of soft consistence, but it is embedded in a similar sloughy, glairy, or fleshy substance, variously tinted and equally homogeneous; and the Avhole is contained in like defined and lined cavities, joined by canals, and finally thus connected Avith the free surface. GroAvth of this kind is frequently more luxuriant than the last described: it may even ])roject externally as a large, lobate, pale mass, which I liaAm never yet noticed in the black variety. That the attendant irritation may be considerable in these instances, is possible enough : suppuration may be conjoined, but sloughing of the soft parts, or necrosis of large fragments of bone does not occur; nor is there any great general vascularity. So thoroughly permeated may be the entire foot that the bones become Avholly absorbed, the muscles disappear, and their place being taken by dense fibrous tissue, the mass seems to be conA^erted int6 a sort of fibro-cartilaginous tumour, AA'liich may be readily cut AA'ith the knife. The super-addition of inflammatory action, AA'ith its consequences, is, liOAveA'er, rare oven in this case. I Avill now mention some common features, and such A^ariations in the anatomy of this parasitic affection, as require separate notice. A section of a much diseased foot ])resents, at first sight, an appearance of general confusion of parts; but this apparent disorder Avill bo found, upon attentive examination, to resolve itself into some degree of method. The pale or non-vascular appearance of the section is another marked feature; there is less vascularity than even in health. The cavities in which are lodged the fungus-particles are neither abscesses nor cysts: the membrane lining them and the canals is sometimes thin, but as often thick, velvety, pale, non-A'ascular, and friable; it is thrown into folds running longitudinally in the canals, but in the larger cavities (AA'hich are but lateral or terminal dilatations of these passages, and on section gAe rise to the semblance of cysts) the membrane is frequently ai-ranged so as to ' Godfrey long since (184-5) noticed the black growth: thus he states that in one specimen a “ cyst or excavated tubercle contained melanotic matter, about the size of a small walnut” .... “its recent appearance was angular and brilliant, much resembling fragments of coal ” . . . . and he adds, “ at present I consider it to be an accidental product in, but not forming part of, this peculiar disease of the foot.”—Bellary Dixpensary Reports. There are surgeons who would agree with the last sentence here quoted; and there are also others who would regard the black fungus as the only truly fungus material.