Success has attended the use of a vaccine prepared from cultures of the organism; and the X-rays and radium, combined with the administration of iodides in large doses, or with intra-muscular injections of a 10 per cent. solution of cacodylate of soda, have proved of benefit.

MYCETOMA, OR MADURA FOOT.—­Mycetoma is a chronic disease due to an organism resembling that of actinomycosis, but not identical with it.  It is endemic in certain tropical countries, and is most frequently met with in India.  Infection takes place through an abrasion of the skin, and the disease usually occurs on the feet of adult males who work barefooted in the fields.

Clinical Features.—­The disease begins on the foot as an indurated patch, which becomes discoloured and permeated by black or yellow nodules containing the organism.  These nodules break down by suppuration, and numerous minute abscesses lined by granulation tissues are thus formed.  In the pus are found yellow particles likened to fish-roe, or black pigmented granules like gunpowder.  Sinuses form, and the whole foot becomes greatly swollen and distorted by flattening of the sole and dorsiflexion of the toes.  Areas of caries or necrosis occur in the bones, and the disease gradually extends up the leg (Fig. 32).  There is but little pain, and no glandular involvement or constitutional disturbance.  The disease runs a prolonged course, sometimes lasting for twenty or thirty years.  Spontaneous cure never takes place, and the risk to life is that of prolonged suppuration.

If the disease is localised, it may be removed by the knife or sharp spoon, and the part afterwards cauterised.  As a rule, amputation well above the disease is the best line of treatment.  Unlike actinomycosis, this disease does not appear to be benefited by iodides.

[Illustration:  FIG. 32.—­Mycetoma, or Madura Foot. (Museum of Royal College of Surgeons, Edinburgh.)]

DELHI BOIL.—­Synonyms—­Aleppo boil, Biskra button, Furunculus orientalis, Natal sore.

Delhi boil is a chronic inflammatory disease, most commonly met with in India, especially towards the end of the wet season.  The disease occurs oftenest on the face, and is believed to be due to an organism, although this has not been demonstrated.  The infection is supposed to be conveyed through water used for washing, or by the bites of insects.

Clinical Features.—­A red spot, resembling the mark of a mosquito bite, appears on the affected part, and is attended with itching.  After becoming papular and increasing to the size of a pea, desquamation takes place, leaving a dull-red surface, over which in the course of several weeks there develops a series of small yellowish-white spots, from which serum exudes, and, drying, forms a thick scab.  Under this scab the skin ulcerates, leaving small oval sores with sharply bevelled edges, and an uneven floor covered with yellow or sanious pus.  These sores vary in number from one to forty or fifty.  They may last for months and then heal spontaneously, or may continue to spread until arrested by suitable treatment.  There is no enlargement of adjacent glands, and but little inflammatory reaction in the surrounding tissues; nor is there any marked constitutional disturbance.  Recovery is often followed by cicatricial contraction leading to deformity of the face.