and, in advanced cases, of the uselessness of the limb for locomotion. In time the foot is no longer put to the ground, different unnatural styles of progression being adopted by different patients.
As the foot enlarges the leg atrophies from disuse; so that in the advanced disease an enormously enlarged and misshapen foot, flexed or extended, is attached to an attenuated leg consisting of little more than skin and bone. In some the tibia, or, if the hand is the seat of invasion, the bones of the forearm become involved; in others the disease at first may be confined to a toe, or a finger, or other limited area. In a very few instances the seat of the disease is the knee, thigh, jaw, or neck. Unless the case be one of actinomycosis the internal organs are never specifically implicated, either primarily or secondarily. The lymphatic glands likewise, although they may be the subject of adenitis from secondary septic infection, are very rarely involved.
After ten or twenty years the patient dies, worn out by the continued drain, or carried off more suddenly by diarrhoea or other intercurrent disease.
Classification, etiology, and histology.— Formerly the tropical forms of mycetoma were classified according to the colour of the mycotic particles in the discharge. Thus we had the white or ochroid, the black or melanoid, and the red forms of mycetoma, the last being a very rare variety. Brumpt's investigations have made possible a classification more scientific than this crude clinical one; the latter, therefore, has to be abandoned.
This authority distinguishes eight different kinds of mycetoma, two of which are caused by species of Discomyces. Of the other six, two are certainly caused by species of Aspergillus. The remaining four are also probably due to species of aspergillus, but, in the absence of cultural evidence, he places them in two provisional groups: one of these, embracing the unpigmented septate species, he names Indiella; the other, the pigmented species, he calls Madurella. Moreover, he has shown that the fungi which give rise to mycetoma may present not only resisting
