. American practice of surgery ; a complete system of the science and art of surgery . th a thorn or splinter, or to some other triflmg injury. * Journ. of Path, and Bacteriol., Edinburgh and London, 1892-93, i., Journ. of Exper. Med., New York, 1898, iii., Lancet, London, 1893, ii., 797. 62 AMERICAN PRACTICE OF SURGERY. Pathology.—In Bocarros series of 100 2ases the disease was located in 93on the foot, 3 on the hand, 2 on the leg, 1 on the shoulder blade, 1 over a sacro-iliac joint. In the two cases on shoulder and sacrum the disease was of the mel-anoid variety and there was no
. American practice of surgery ; a complete system of the science and art of surgery . th a thorn or splinter, or to some other triflmg injury. * Journ. of Path, and Bacteriol., Edinburgh and London, 1892-93, i., Journ. of Exper. Med., New York, 1898, iii., Lancet, London, 1893, ii., 797. 62 AMERICAN PRACTICE OF SURGERY. Pathology.—In Bocarros series of 100 2ases the disease was located in 93on the foot, 3 on the hand, 2 on the leg, 1 on the shoulder blade, 1 over a sacro-iliac joint. In the two cases on shoulder and sacrum the disease was of the mel-anoid variety and there was no doubt about the diagnosis. As in actinomycosis^the process extends in the affected part hy contiguity, disregarding anatomicalboundaries. General infection or metastasis through the blood is unknown, noris the disease carried along the lymph stream. The proliferation of the fungus lodged in the subcutaneous tissue sets up areactive inflammation, by which nature endeavors to arrest the process and shutoff the parasite. For this reason the focus in the soft parts is surrounded by a. Fig. 21.—Mycetoma. Melanoid variety. Mode of invasion of the growth. Semi-scheniatic. Ata, a, cyst-hke cavities filled with the black, roe-like, granular masses; h, b, sinuses, withc, c, external openings; and d, d, pinkish stains or streaks in the skin near the openings. Above, aretwo canals traced out of an actual specimen. {After H. V. Carter.) zone of proliferating cells and more or less organized fibrous tissue. Aroimd thefoci in the bones this forms a tough membranous capsule which can be enucle-ated entire. The foci vary in number and size and distribution. They are con-nected, one with another, by a network of ramifying sinuses (see Fig. 21). Inthe early stages the soft parts and in later stages the bones are riddled with thefoci and sinuses. Tendons and fasciae resist the process longest. On section ofa far-advanced mycetomatous foot or hand, an oily, greasy surface is shown
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