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Scientific Memoirs by
concretions ordinarily associated with it. Of course, on the presumption that the
fungal elements are the primary and essential cause, this is a question which is
not open to discussion, but, when cases of disease are encountered which both
clinically and structurally are essentially identical with typical cases of my-
cetoma, save as regards an entire absence of concretions and fungal elements,
it is one which naturally suggests itself to any unprejudiced mind and which
must be determined by the nature of the evidence adduced in regard to the
general identity of the two forms of disease and the absence of fungal elements
in one of them.
I have, however, as I believe, met with two cases in which both of these
points were quite unequivocally demonstrable. They both occurred in patients
who were admitted into the Medical College Hospital, Calcutta ; in both cases
the disease occurred in the foot ; and in both the specimens reached me in the
fresh condition immediately after they had been removed by amputation. In
both cases the foot presented all the characteristic external appearances of
mycetoma, being thickened and shortened, with extreme flattening of the plantar
arch and with numerous mammilations of the surface, which in some instances
presented orifices leading into the substance of the tissues. Sections revealed
the usual and characteristic system of cyst-like cavities and intercommunicating
sinuses, but the contents of these consisted entirely of fluid mucoid or oily
materials, and, in spite of the closest scrutiny, failed to shew any traces what-
ever of the presence of concretions of any kind. A specially strict search for
such bodies was made, as the specimens had been procured in the fresh state
for the special purpose of obtaining materials for attempted cultures of the
fungal elements, but all attempts to detect any proved entirely futile.
Here then were instances of a disease in which the lesions were precisely
of the same character as those which are ordinarily associated with the presence
of fungal concretions, and which clinically were regarded as cases of mycetoma,
but which had seemingly arisen quite apart from the presence of any fungal
elements, or, at all events, from the presence of any hyphomycete fungi. It
thus became necessary to look for some other cause accounting for the morbid
phenomena, and in doing so a very extensive series of preparations was made
which certainly revealed the presence of no filamentous fungi, but showed
clear evidence of the existence of widely diffused textural changes.
The very peculiar character of the contents of the cavities and channels
and, specially, the conspicuous evidences of the abundance of fungal elements
in the concretions of the black variety of the disease, would appear in great
measure to have diverted the attention of most observers from the study of the
phenomena presented by the surrounding tissues. The accounts of these
phenomena which have been recorded are extremely meagre and appear to leave
one very important point entirely out of consideration. This is the evidence
of very extensively diffused vascular disease of the nature of arteritis obliterans