A CASE OF MYCETOMA 
(MADURA FOOT) 
by 
JAMES H. WRIGHT 
(From the Laboratory of the Massachusetts General Hospital) 
From / ■ 
THE JOURNAL OF EXPERIMENTAL MEDICINE 
VOL. 111, Nos. 4 AND 5, 1898 A CASE OE MYCETOMA (MADURA EOOT). 
By JAMES H. WEIGHT. 
(From the Laboratory of the Massachusetts General Hospital.) 
Plates XXXIX and XL. 
Mycetoma is a chronic inflammatory process, most commonly affect- 
ing the tissues of the foot, in which suppurative nodular swellings, 
sinus formation, and enlargement and distortion of the parts are 
prominent features. The bones may become involved and undergo 
a rarefying osteitis. 
The affection is characterized by the presence in the diseased tissue 
and in the discharge from sinuses, of peculiar granules, usually not 
more than one millimetre in diameter, hut sometimes larger. These 
granules in certain cases are of a black color, of irregular shape, and 
are hard and rather brittle. In general they resemble grains of gun- 
powder. In other cases the granules are whitish, greyish or yellowish 
in color and are of a soft or cheesy consistency. They have been 
compared to fish-roe in appearance. A very few cases are also re- 
corded in which the granules were of a red color. There is no good 
evidence to show that more than one kind of granules are ever present 
in any one case of the disease. 
On account of the fact that at least two very different kinds of 
granules are found associated with the lesions, two varieties or forms 
of the disease are recognized: the “melanoid” or black variety, in 
which the granules are black, and the “ ochroid ” or pale variety, in 
which the granules are white to yellow in color. A. Vandyke Carter, 
who was the first to show that mycetoma was a special pathological 
process and to name the disease itself and its varieties, considered the 
granules to be the cause of the affection and regarded them as repre- 
senting stages in the life history of one and the same fungus. Carter 
claimed that he had cultivated this fungus and that it grew as a pink 422 
A Case of Mycetoma (Madura Foot) 
mould. This pink mould was studied by H. J. Berkeley and named 
by him “ Chionyphe Carter!.” The connection between this pink 
mould and the granules was not clearly demonstrated, owing to the 
conditions under which the cultivation experiments were made, so 
that the pink mould has not been generally believed to represent the 
infecting organism in the process. There can be little doubt, how- 
ever, that Carter saw and recognized in the black granules the same 
fungus elements which have been described by later observers. This 
is quite apparent from an examination of the plates in his monograph,* 
published in 1874. 
It is now reasonably certain, however, that the organism of the 
black granules is of an entirely different character from the organism 
or organisms making up the pale or yellowish granules. Therefore 
in summarizing the results of various observers who have studied the 
nature of these granules, observations on the black granules will be 
considered separately from those upon the pale or yellow granules. 
The disease is endemic in India and has been observed in Africa, 
Italy and other tropical or sub-tropical countries. In America it is of 
very rare occurrence, only three undoubted cases, in all, having been 
reported up to the present time. These are the cases of Adami and 
Kirkpatrick,! of Hyde, Senn and Bishop,! and of Pope and Lamb.§ 
These were all of the ochroid variety of the disease. In a case re- 
ported by Kemper and Jameson,)) the diagnosis is open to serious ques- 
tion, so that it is not included in the list. 
Observations on the granules of the melanoid variety. studied 
the black granules in a single case. He found them to consist “of 
densely aggregated ramifying tubules ” embedded in a dark colored 
matrix. They frequently showed dilatation into round or ovoid cells. 
These structures he considered to be elements of a fungus identical with 
*A. Vandyke Carter. On mycetoma or the fungus disease of India. 
London, 1874. 
t Trans, of the Assoc, of Amer. Physicians, 1895; Montreal Medical Journal, 
January, 1896. 
% Journal of Cutaneous and Q-enito-Vrinary Diseases, xiv (1896), 1. 
§ New York Medical Journal, September 19, 1896. 
|| American Practitioner (Louisville), xiv (1876), 129, 
Trans. Path. Soc., London, 1871. James H. Wright 
423 
that described by Carter. No- cultivation experiments were made. 
Bristowe’s description and drawings of the microscopical appearance of 
the granules are very satisfactory. It is quite evident that he had 
before him the same organism as that seen by Carter in the black 
granules. 
Hogg * also examined a case of the melanoid variety, finding also fun- 
goid structures in the granules, which, to Judge from his description, 
were evidently the same as those described by Carter and by Bri stowe. 
In 1888 Bassini f described a case of the black variety which occurred 
in Italy. The granules were found to be made up of a mycelium of fila- 
ments imbedded in a dark brown matrix. These filaments were septate, 
4to 6 millimetres in diameter, and. showed irregular swellings. They 
had a general radiate arrangement in the granule. Besides the granules 
Bassini noted the presence of strings or cords made up of the same 
fungus filaments imbedded in a brown matrix. Ho spore-bearing organs 
were found and no cultivation experiments were made. The mycelium 
was regarded as representing “ an imperfect vegetative form of a fungus 
which, in a state of perfect evolution, would be furnished with a true 
reproductive apparatus.” Leucocytes and young blood-vessels were noted 
in the tissues about the granules. 
Kanthaek J studied three cases of the melanoid variety in microscopi- 
cal sections. In all of these cases he found that the black granules 
seemed to consist, in some instances, of a structureless, olive brown, glassy 
or finely granular material, in which were imbedded hollow filaments of 
varying calibre, having a well-marked radial arrangement. Kanthaek 
regarded these appearances as representing degenerative changes, and 
sought to show that the granules were made up of an organism closely 
related to actinomyces, as he had found in the case of the pale granules. 
It is manifest from his description, however, that he saw the same fungus 
mycelium in the black granules which had been noted by previous 
observers. 
The latest and most satisfactory paper on the structure and nature of 
the black granules is that of Boyce and Surveyor. § They studied seven 
cases of the melanoid form and found in all of them that “ the black 
particles represent a curious metamorphosis of a large, branching, septate 
fungus.” This fungus was imbedded in or surrounded by a brown pig- 
ment substance which was readily removed by “ Eau de Javelle.” The 
* Trans. Path. Soc., London, 1872. 
t Archiv. per le scienze mediche, 1888, xii (1888), 309. 
% Journal of Path, and Pact., i (1893), 140. 
§ Trans, of the Royal Society of London, 1894; Proc. Royal Soc., London, 1893. 424 
A Case of Mycetoma (Madura Foot) 
hyphse showed great variations in the size and shape of their segments. 
They were branched and often disposed in a radiate manner at the 
periphery. No organs of fructification were observed. The fungus was 
not cultivated. 
Observations on the ochroid variety. Carter’s view that the pale parti- 
cles represented a stage in the evolution of the same fungus as that 
making up the black granules has already been mentioned. 
In 1870 Moxon and Hogg * examined a case of this variety. They 
found that the granules showed in some instances a texture of fine 
fibrils, but they were unable to come to any conclusion as to their nature. 
Kanthack \ examined histologically twelve specimens of the ochroid 
variety and states that “ the parasite of the ochroid variety agrees 
morphologically and structurally with the typical and perfect ray fungus, 
and there can he no reasonable doubt that both belong to the same 
botanical group.” 
Vincent X found that the granules in a case of the pale form of the 
disease were made up of a streptothrix, which grew upon potato with a 
marked red color. In a later paper published with Gemy,§ Vincent 
reports isolating in cultures the same streptothrix from a second case. 
Hewlett 1| examined two cases of the ochroid variety and states that 
the granules were very like colonies of actinomyces in structure. He 
considered that the process was actinomycosis. 
Boyce and Surveyor studied eighteen cases, and conclude that “ the 
white particles consist largely of caseous material and of the remains of 
a lowly organized fungus, presenting in very many instances some of the 
characteristics of the fungus of actinomycosis.” This organism they 
regarded as entirely distinct from that found in the seven specimens of 
the melanoid variety which they examined. 
Boyce** also reports having cultivated a streptothrix from a case of 
the ochroid variety. This streptothrix differed in its cultural peculiari- 
ties from other similar organisms. 
Ada mi and Kirkpatrick f f conclude, from an examination of the case 
of the ochroid variety observed in Canada, that the granules “ were 
* Trans. Path. Soc., London, 1870. 
t Loc. cit. 
% Annates de Vlnst. Pasteur, viii (1894), 129. 
§ Annates de dermatologic et syphilographie, Paris, 3me ser., t. vii, Nov., 1896, 
|| Trans. Path. Soc., London, 1893. 
Loc. cit. 
** Hygienische Rundschau, iv (1894), 529. 
ft Loc. cit. James H. Wright 
425 
identical in general appearance with, actinomyces, forming lobate, reni- 
form masses with central dense mycelium and a radiate arrangement of 
filaments or clubs around the periphery. These clubs, however, were 
larger than those of actinomyces.” 
Bishop,* in the paper published with Hyde and Senn, gives the results 
of his microscopical examination of a case occurring in Chicago. The 
granules by direct examination were made up of a dense granular central 
portion and a more transparent peripheral portion in which an obscure 
radial striation could be observed. No clubs were observed at the peri- 
phery. In sections of the tissues the granules consisted of more or less 
rounded masses, often having a scalloped border and occurring singly 
and in groups. The central portions stained faintly with hematoxylin. 
Under a high magnifying power delicate filamentous threads, having 
more or less of a radial arrangement, were to be made out in the masses, 
and, at the margin of some, delicate radiating lines. There was much 
to suggest actinomycosis. The tissue changes consisted essentially in 
the formation of granulation tissue in which giant cells were present. 
From a consideration of the results of this list of observers it is 
quite evident that the disease known as mycetoma is due to at least 
two different organisms, or in other words, that the black granules of 
the melanoid form are composed of an organism entirely different 
from the organism or organisms making up the pale or ochroid 
granules. 
There can be little doubt that the melanoid granules are composed 
essentially of a fungus or a hyphomycete, and that probably one and 
the same fungus has been seen by all observers. 
The chief thing lacking in these studies of the melanoid granules 
has been the growing of this fungus. This cultivation has been ac- 
complished in the case reported below. 
As to the nature of the granules in the ochroid form it is difficult 
to form an opinion in some of the cases. It seems clear that, in most 
of them at least, the granules are composed of organisms of the 
streptothrix group, to which actinomyces is now generally thought to 
belong, and not to be the more highly organized hyphoinycetes. That 
some of the cases of the ochroid variety are nothing more or less than 
actinomycosis seems not unlikely. 
* Loc. cit. 426 
A Case of Mycetoma (Madura Foot) 
On account of the rarity of this disease in America, and because of 
the interest attaching to the parasite, the following case is reported: 
Clinical History. The patient, an Italian woman, aged twenty-six, 
was admitted to the service of Dr. H. H. A. Beach, in the Massachusetts 
General Hospital, December 39, 1897. She was first seen in the Out- 
Patient Department by Dr. C. A. Porter, who recognized the condition 
as probably madura foot. The tissues of the left foot in the region of 
the base of the second and third toes on the plantar aspect presented a 
swollen appearance with desquamation of the epithelium. In the skin 
over this swollen area there was a small sinus, from which exuded on 
pressure a dirty, greyish fluid, containing some black, hard, irregular 
granules like grains of gunpowder. On the dorsum of the second toe, 
near its tarso-metatarsal joint, there was a small ulcer. 
The disease was first noticed in July, 1897. The patient had lived in 
America several years. A piece of tissue was excised from the second 
toe for microscopical examination, and from the residts of this, as well 
as from the appearance and character of the black granules associated 
with the condition, the diagnosis of mycetoma, or madura foot, of the 
melanoid variety Avas made. Amputation of the four toes, together with 
a part of the four corresponding metatarsal bones, was performed by Dr. 
Beach. 
The dissection of the amputated part shoAved the folloAAung condi- 
tions : In the soft tissues of the plantar side of the foot near the tarso- 
metatarsal articulations and immediately beneath the skin was a 
pigeon’s-egg sized, ovoid tumor nodule, sharply defined from the sur- 
rounding tissue (Plate XXXIX, Fig. 1). This nodule on section con- 
sisted of a soft, in places gelatinous, myxomatous-like tissue, traversed 
by an indefinite reticulum, which divided it into indefinite small areas; 
in these areas were imbedded black, irregular granules less than a 
millimetre in diameter, resembling grains of gunpowder. These gran- 
ules occurred singly and in groups. In one or two places the tissue of 
the nodule was opaque and yellowish, as from necrosis. Two other sim- 
ilar nodules of small size, containing black granules, Avere also present. 
One Avas situated in the soft tissue of the dorsum of the foot near the 
base of the second and third toes; the other in the soft tissue of the first 
phalanx of the second toe. The larger of these nodules was about the 
size of a pea. The bones were not involved. James H. Wright 
427 
The structure of the black granules. Macroscopically the granules 
are of an irregular or mulberry shape, of a black or dark brown color, 
and usually less than one millimetre in diameter. They are some- 
times bound together by shreds of tissue or of exudate. They are 
hard, rather brittle, and are not readily broken up under a. cover-glass. 
Microscopically they present the appearance of irregular, lobate 
masses of a dark brown or black opaque substance. Upon being 
broken up and examined with high magnifying power, little more than 
indefinite, brown, somewhat refringent masses can be made out. 
Occasionally structures suggestive of fungus may be seen, but there 
is little else to indicate a vegetable nature. They are very resistant 
to most reagents, bnt by soaking them for a few minutes, with or with- 
out heating, in the ordinary hospital solution of sodium hypochlorite, 
they lose their brown or black color and become more or less com- 
pletely white and soft, according to the duration of the action of the 
reagent. A strong solution of potassium hydroxide also softens them 
to a certain extent, but does not bleach them so quickly. 
Granules from the hardened specimen, bleached and softened as 
above outlined, when crushed and dissociated under a cover-glass, are 
found to consist of a mass of fungus structures together with more or 
less brown pigmented imbedding, or investing material, as described 
and figured by Boyce and Surveyor,* and others. 
Under a high magnifying power (Plate XL, Pig. 7) the greater 
part of the mass of the granules is seen to consist of ovoid or rounded, 
translucent bodies of varying sizes, closely packed together, having 
homogeneous interiors or containing a few refractive granules. Among 
these bodies typical septate, branching hyphae may be seen, sometimes 
showing dilatation or varicosities of their segments. The ovoid or 
rounded bodies seem to be dilated or degenerated hyphal segments, 
for not only may they be seen in continuity with the hyphae, but 
transitions between them and the hyphae with swollen segments may 
be made out. 
The periphery of the granules has the appearance of being made 
* Loc. cit. 428 
A Case of Mycetoma (Madura Foot) 
up of closely set, radiating hyphse, usually showing more or less swell- 
ing or degenerative changes in their segments. 
Xo undoubted spore-bearing organs were observed, but occasionally 
a large spherical, thick walled body containing smaller rounded or 
ovoid or elongated refringent bodies was observed. These were re- 
garded as representing some peculiar mode of growth or an “ involu- 
tion,” rather than spores and spore-bearing organs. 
In specimens treated with caustic potash solution, when the removal 
of the interstitial pigmentary substance is not complete, branched 
hyphal tubes may be made out imbedded in a brown refringent sub- 
stance. 
The test for hsemin in the black granules was negative. 
In sections of the tissues, under the microscope, the granules are 
seen as rounded, lobate, reniform or irregular bodies of a more or less 
reticular structure in general (Plate XXXIX, Pigs. 2 and 6, Plate 
XL, Pig, 8), They are deeply stained by the basic aniline dyes, but 
are not stained by hsematoxylin. 
In sections stained with the latter they appear to be chiefly com- 
posed of a brown-colored, somewhat hyaline substance, arranged 
throughout the main portion of the granules in the form of a reti- 
culum and in indefinite or rounded clumps. This substance at the 
margin may merge into a narrow zone of yellow, very hyaline refrac- 
tive material, in which more or less of a radial striation may some- 
times be apparent. 
The results of the study of the granules in sections stained in 
various ways may be summarized as follows: 
The granules, as a rule, are made up of a central portion and a 
cortical portion or rind, without any definite separation between them. 
In the central portion are usually branching trabeculae and rounded 
masses, composed of a hyaline substance, in the midst of which are 
numerous structures like fungus elements, cut in various planes. In 
some instances the central portion is made up mainly of an amorphous 
or indefinite material with only a few fungus hyphae. In general the 
central portion is less dense in structure than the cortical portion or 
rind. The latter in most cases consists of a hyaline material, con- James H. Wright 
429 
tinuous with the hyaline trabeculae of the central portion, in which 
fungus elements are imbedded, sometimes arranged more or less in 
a radiate manner, sometimes not. The margin is irregularly scalloped 
or dentated. In some cases the cortical portion seems to be made up 
of more or less atypical hyphse and elongated processes of hyaline 
substance radially disposed. In a very few instances the granules 
appear in the sections as irregularly shaped masses of homogeneous, 
hyaline or fine granular material, in which unstained or empty fungus 
tubules or hyphas are embedded (Plate XL, Fig. 8). 
In brief it may be said that the granules are composed of a myce- 
lium of hyphse or fungoid elements, more or less degenerated, em- 
bedded in or surrounded by a hyaline brown-colored refringent sub- 
stance, which itself forms more or less of a reticulum. 
The Gram stain and the Weigert fibrin stain, or modifications of 
them, stain the substance of the granules, to a variable extent depend- 
ing on the amount of the decolorizing agents applied. The marginal 
portions of the granules hold the stain longest. In only a very few 
instances could the hyphse be differentially stained by these methods. 
Cultures. About sixty-five of the black granules were planted in 
various culture-media after having been washed in sterilized bouillon 
to remove contaminating organisms as much as possible. Xearly all 
of these granules were taken from freshly cut portions of the nodules 
of the foot after amputation. From approximately twenty-five of the 
sixty-five granules, a growth of a hyphomycete was obtained. The 
original cultures, with one or two exceptions, showed more or less 
contamination with the staphylococcus albus, which was abundantly 
present in the diseased tissue. The exceptions were in the cases of 
one or two grains obtained from the sinuses before the amputation and 
after peroxide of hydrogen had been used at intervals in the sinuses. 
This reagent had probably destroyed most or all of the pus cocci 
adherent to the grains, so that the washing in sterile bouillon sufficed 
to render it free from living contaminations. 
The growth in all cases began from the grain and appeared after 
about four or five days or later. On solid culture-media it first ap- 
peared as a tuft of delicate, whitish filaments springing from the black 430 
A Case of Mycetoma (Madura Foot) 
grain. These in the course of a few days increased in number and 
length, and in the case of the potato formed a dense, whitish or pale 
brown felt-work or membrane, having a tendency to spread widely 
(Plate XL, Pig. 12). 
Grannies planted in potato infusion, in which the contaminating 
cocci grew only feebly, and grannies obtained free from contamination 
and planted in bouillon, showed after four or more days a faint greyish 
halo about their peripheries. In the course of some days this in- 
creased in size and was seen to consist of long, delicate, radiating fila- 
ments (Plate XL, Pig. 9), which grew in length until they reached 
the wall of the tube and produced the appearance of a powder puff-ball, 
with the granule in the centre (Plate XL, Pig. 11). Granules were 
readily obtained free from bacterial contamination and planted in 
bouillon for development, by selecting those grains which, after re- 
maining on solid culture-media for several days, were well separated 
from colonies of cocci. Many of the granules, i. e. about forty out 
of the sixty-five, failed to develop any fungus. This fact bears out 
the idea that many of the fungus elements in the granules are degen- 
erated, as has been mentioned. 
The character of the hyphomycet© may be summed up as follows: 
Morphology (Plate XL, Pigs. 8 and 10). Long branching hyphse 
from 3to 8 ain diameter. In the younger ones delicate transverse 
septa are present. In the older forms there may be swellings at these 
points, and the liyplue may appear as a string of oval-ended, plump 
segments. The filaments have a definite wall and in their interior, 
granules or pale areas may be seen. The branching occurs by the 
formation of lateral outgrowths or buds. Xo spore-bearing organs 
were observed. 
Potato. It forms a dense, widely spreading, coherent membrane, or 
layer, of velvety surface, pale brown in color throughout its central 
jDortions, and white at its peripheral portions. A marked feature is 
the appearance of small spherical globules or droplets of dark, coffee- 
colored fluid on the surface of this layer. The potato takes on a dark 
brown color and becomes very moist (Plate XL, Pig. 12). 
Bouillon. The growth always proceeds from the planted material, James H. Wright 
431 
whether grain or fragment of mycelium, in the form of fine radiating 
filaments, and soon produces a puff-ball appearance (Plate XL, Pigs. 
9, 11). Eventually the whole area of fluid is filled up with the radiat- 
ing mycelium and a definite mycelial layer is formed at the surface. 
The medium acquires a deep coffee-brown color. 
Potato Infusion. This was prepared by boiling about 20 grins, 
of potato in water, filtering and making up to 1000 cc. without neutral- 
izing, as used by Vincent.* In this the growth proceeds as in bouillon, 
except that no surface layer is formed. A peculiarity, however, noted 
in old cultures consists in the appearance of numerous black gran- 
ules, about 1 mm, or less in diameter, in the midst of the mycelium. 
These granules consist of closely packed spherical or polyhedral 
cells, together with some short, thick, segmented hyphse. The walls 
of these cells have a black appearance and masses of them are black and 
opaque under the microscope. They seem to represent masses of 
interlacing hyphse whose segments have been much shortened and 
widened, and otherwise changed. 
These black masses were kindly examined by Prof. AV. G. Parlow 
of Harvard University, who considered them to be u sclerotia.” 
Agar-Agar (plain and glucose). The growth appears as a mesh- 
work of widely spreading filaments, of a greyish color, on the surface 
of the medium. In old cultures black “ sclerotia ” are found as in 
the potato infusion. In stab cultures growth appears only at the 
surface. 
Xo results were obtained from the inoculation of animals with the 
original granules or with cultures. 
Pathological Histology. The tissue composing the nodules consists 
essentially of a formation of more or less atypical connective tissue, in 
various stages of development, in which foci of suppuration are pres- 
ent in association with the granules. 
Some of the granules lie in small cavities containing polynuclear 
leucocytes, loose epithelioid cells and cellular detritus. These cavi- 
ties may be lined either by a wall of vascular granulation tissue or by 
masses of epithelioid cells, together with multinucleated giant cells 
* Loc. cit. 432 
A Case of Mycetoma (Madura Foot) 
(Plate XXXIX, Pigs. 2 and 4). Other granules are closely invested 
by a zone of epithelioid and giant cells, and outside of this there may 
be an infiltration with lymphoid and plasma cells. The nodule thus 
formed about the granule resembles very closely a tubercle in struc- 
ture. This tubercle-like formation is shown in Plate XXXIX, Pigs. 
5 and 6. The giant cells are often of large size and may have a peri- 
pheral arrangement of their nuclei. They are a very prominent 
element in the lesions. 
The primary effect produced by the parasites upon the tissues 
seems to be the development of nodules of epithelioid cells and of 
giant cells from the tissues immediately about them. Later, suppu- 
rative processes occur in the nodules and abscesses are formed, which 
in time give rise to the development of granulation and connective 
tissue in large amount. 
The writer is under obligations to Dr. 11. 11. A. Beach, of the Staff 
of the Massachusetts General Hospital, and to Prof. W. G. Farlow, of 
Harvard University, for courtesies shown him in connection with the 
study of this case. 
The photographs which accompany this paper were made by Mr. 
Louis F. Brown. Por valuable instruction and suggestions in their 
preparation the writer is greatly indebted to Mr. John G. Hubbard, 
of Brookline, Mass. 
All of the figures are photomicrographs from original specimens. 
DESCRIPTION OF PLATES XXXIX AND XL. 
Plate XXXIX. 
Fig. 1. Portion of amputated part showing the black granules and gen- 
eral character of the lesions as seen with naked eye. 
Fig. 2. Section showing black granules and general features of the lesions 
as they appear under a low magnifying power—Zeiss a 2. 
Figs. 3, 4, 5 and 6. Sections showing the granules and surrounding cells. 
All, with the exception of Fig. 4, taken with Zeiss apochromat. 16 mm. 
Fig. 4 taken with Zeiss apochromat. 4 mm. Figs. 5 and 6 represent the 
tubercle-like nodules, with the parasite in the centre, as described in the 
text. 
Plate XL. 
Fig. 7. Fungus elements from a granule after bleaching and softening 
with sodium hypochlorite solution. A branching, septate hypha is shown. 
Zeiss apochromat. 4 mm. James IT. Wright 
433 
Fig'. 8. Section showing margin of two contiguous granules, highly mag'- 
nified. Zeiss apochromat. 2 mm. 
The small clearer areas represent fungoid elements. The darker sub- 
stance represents the hyaline imbedding substance. 
Fig. 9. Black granule with mycelial growth proceeding from it. Zeiss a 2. 
Culture in bouillon. 
Fig. 10. Showing structure and appearances of the hyphas of the myce- 
lium obtained from the granules. Zeiss apochromat. 4 mm. 
Fig. 11. Two bouillon cultures showing the powder puff-ball appearance. 
In one the black granule is seen in the centre of the growth. 
Fig. 12. Potato culture of the hyphomycete obtained from the granules. 
The black globules are composed of a dark brown fluid. THE JOURNAL OF EXPERIMENTAL MEDICINE. VOL. 11l 
PLATE XXXIX. 
2 
3 
4 
5 
6 THE JOURNAL OF EXPERIMENTAL MEDICINE. VOL. 11l 
PLATE XL. 
7 
8 
9 
10 
H 
12