of the body. It is characterized by enlargement and deformity of the part; an oily degeneration and general fusion of the affected tissues; the formation of cyst-like cavities communicating by sinuses, and containing mycotic aggregations in an oily purulent fluid which escapes from fistulous openings on the surface. The disease runs a slow course, is never recovered from spontaneously, and, unless removed, terminates after many years in death from exhaustion.
History and geographical distribution.—The earliest notice of this disease we owe to Keempfer (1712). Its more modern history commenced with Godfrey of Madras, who, in the Lancet of June 10th, 1843, gave a description of several unquestionable examples under the title, " Tubercular Disease of the Foot." Subsequently, Balingall (1855), who was the first to suggest its parasitic nature, Eyre (1860), and others added considerably to our knowledge of the subject. The merit of bringing the disease prominently before the profession, and of distinctly describing its clinical and anatomical features, as well as of suggesting its true pathology, belongs entirely to Vandyke Carter, who, from 1860 to 1874, in a series of important papers, furnished the information on which all later descriptions have been principally founded. Carter was the first to point out the presence of mycotic elements in the discharges coming from the implicated structures, and in the contents of the characteristic cysts and sinuses with which they are honeycombed, and showed that the disease was allied to actinomycosis. Recently much information has been supplied by Wright, Nicolle, Laveran, Bouffard, and, especially, by Brumpt.
In India mycetoma is endemic in districts more or less limited. These districts are scattered over a wide area, the intervening regions— in some instances whole provinces, as that of Lower Bengal— enjoying an almost complete immunity. It appears to be acquired only in rural districts, the inhabitants of the towns being exempt. Among the more afflicted districts may be mentioned Madura— hence the name "Madura foot" by which mycetoma is often known— Hirsar, Ajmeer,
