. The American journal of tropical medicine. dule is convex. They extend on the second toe nearly to thenail. On the outer side a few extend posteriorly nearly to the verticalplane of the external malleolus. Where most abundant they are inclose contact and may coalesce. The apex of many is ulcerated, andthe ulcerations mark the openings of definite sinuses, extending intothe foot. The color of the nodules is paler than the normal skin. Someof the nodules are slightly polypoid. MYCETOMA IN NORTH AMERICA 245 Plantar: A nodule similar to the foregoing may be seen on eitherside of the third toe. N
. The American journal of tropical medicine. dule is convex. They extend on the second toe nearly to thenail. On the outer side a few extend posteriorly nearly to the verticalplane of the external malleolus. Where most abundant they are inclose contact and may coalesce. The apex of many is ulcerated, andthe ulcerations mark the openings of definite sinuses, extending intothe foot. The color of the nodules is paler than the normal skin. Someof the nodules are slightly polypoid. MYCETOMA IN NORTH AMERICA 245 Plantar: A nodule similar to the foregoing may be seen on eitherside of the third toe. None are seen on the sole, except a small clusterabout 2,5 cm. posterior to the tarsophalangeal articulation of the greattoe. These nodules protrude through the epidermis of the sole, whichseems to be punched out at their base. They are yellowish in colorand several are marked by sinus openings. Internal changes: The foot was divided into eight sections by seventransverse incisions. It was necessary to use the saw to cut bone ineach Fig. 5. Foot of Case 2S (Kirkhamj The subcutaneous fat on the plantar aspect appears normal in amount,but it has disappeared from the dorsum. The dorsal tendons havepartly disappeared. Most muscles, except those attached to the oscalcis have disappeared. The place of the fat is taken by a dense massof connective tissue, which extends to the bones. Above the bony arch are numerous sinuses, some lying singly, otherscloselj^ grouped, surrounded by dense strands of connective are from 1 to 2 mm. in dianu^ter, though they may have expansions4 mm. wide. A few are filled with translucent material, others appearempty. In some are seen y(>llowish, mulberry shaped granules, notover 1 mm. in diameter, apparently filling the entire lumen of the sinuses are lined by a yellowish necrotic membrane of varying 246 MARK F. BOYD AND EARL D. CRUTCHFIELD thickness. The sinuses extend up to the summits of the cutaneousnodules. These nod
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Keywords: ., bookcentury1900, bookdecade1920, booksubjecttropica, bookyear1921
