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

  • Carter, H. V. (Henry Vandyke), 1831-1897.
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 Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    swelling extended, without much pain, over the foot towards the ankle, which became implicated only a year or BO hack. Amputation of the leg was performed by Mr W. Gr. Hunter on October 3rd, 1859, and the patient made a slow but complete recovery. The amputated member was examined by me within two hours after removal, and a coloured drawing was made of the parts as seen on section of the foot. It needed but a glance to see that the characteristic features of the disease were numerous black masses, studded throughout both hard and soft parts. {Vide Plate I.) The lower end of the^iJ/ahas imbedded in its cancellous tissue two isolated and spherical masses, the size of a marble, and of the darkest pigmentary hue ; the anterior portion of the os calcis is occupied by a still larger and more irregular mass, composed in part of smaller black spherical bodies, and also of a fleshy substance inter- mixed. Beneath the sJcin at the fore part of the dorsum of the foot are numerous round, dark-coloured masses which are seen to be composed of black spherical particles aggregated together; the extensor tendons of the toes have been displaced by this collection. Beneath the first phalanx and heads of the metatarsal bones are other masses of the same appearance; and before and behind the ankle-joint are also glairy accumulations, in which are imbedded black particles. All the other tissues exhibited a normal appearance, and there was here little of that elephantiasis-like thickening of the skin which was subsequently found to be common in the fungus-disease : there was nothing like strumous deposit in the osseous tissue, or such fusion of parts as is observed in cancer, and no caries or inflammation of the articulations. The black bullet-like masses may be picked out quite clean, and the cavities they occupied appear to be lined by a distinct membrane; they were carefully drawn, and figures of them and of the foot itself are preserved. The bones were macerated, and are now preserved in the Grant College Museum. The minute structure of the fungus will be described further on. Case 2.—In February, 18G0, I received from Bhooj, in Kutch, an entire foot which was kindly forwarded by Mr Sudasew Hemraj, physician to the llao of Kutch. No history of the case reached me, but having received further information from the donor, I am led to believe that the present specimen was but a type of the cases commonly occurring in Kutch. The whole foot has the globular shape characteristic of these cases: there are several apertures placed in the dorsum and on cither side of the ankle and foot, but none in the sole; they resemble those of the first specimen, and some are occupied by little black grains, identical with the particles forming the deposits in the interior, to be presently described. The skin presents white patches scattered around these apertures, and the toes are displaced upwards. A coloured sketch was made of both exterior, and of sectional appearance. See Plato II, fig. 1, for the external aspect of this specimen. Description of section.—The tibia (and probably the fibula) are seen to bo free from black deposit in this case: there is, however, a thinning of the walls of the shaft, and there may be noticed a softened spot placed on a part which is paler in colour than the rest of the cancellous tissue, although of the same density ; this softened spot has a rather white tint, and it looks as if fat had been deposited there. Also in the os just behind the position of the bursa mucosa of the tendo Achillis,i\\e osseous tissue is somewhat softened, hut not changed in colour. On careful examination of these parts, only a large increase of fat-cells, crystals ofstearine (free and con- tained) and the remains of the medullary membrane studded with granular nuclei, were found: no fungus- particles were detected. The astragalus is unaffected. In the fore-part of the os calcis is embedded a black mass, half an inch in diameter, granular and firm in consistence, and of the characteristic rounded form. The cuneiform bones are occupied by a larger deposit of similar appearance; and beneath the thickened integument covering them, being partially blended with the above, are seen two round black deposits, a quarter of an inch in diameter; also a third deposit a little further back ; and again in the soft parts beneath these bones, in the sole of the foot, are two other masses of similar appearance : smaller deposits are seen beneath the toes in front. The integument is thickened somewhat, as seen in elephantiasis, in the dorsum of the foot; and there appears to have been some fibrous thickening amongst the parts in the sole. The joints are unaffected. The osseous tissue is mostly in a normal state, and only absorbed to make room for the new growth, thus leading to the production of small spherical cavities. As for the fungus masses, compared with those of the first specimen, they are somewhat less firm and regular when enucleated from midst the tissues, but in all other respects they are identical with them: in some instances, e.g. those taken from the cavity in the os cuneiforme, the mass is soft, friable, like rotten wood, and splitting in a direction radiating from the centre : their colour is however the same, and similar masses were found in the first specimen.