Gangosa is chiefly to be differentiated from leprosy, syphilis and lupus vulgaris. Its more rapid course should distinguish it from leprosy and lupus and the history from syphilis.
Treatment
Odell found that a thorough antisyphilitic treatment cured these ulcerations. He used mercurial injections. Recently salvarsan has been used with striking curative results. It has been thought that local application of tincture of iodine was effective in stopping the progress of the early ulcerations but this would seem doubtful, it being advisable immediately to give salvarsan.
On account of the offensive odor of the discharge solutions of permanganate of potash have generally been used.
CHAPTER XXVIII
MYCETOMA
General Remarks
Various destructive processes of different parts of the body, but more commonly of the foot, which are caused by invasion and growth of fungi are generally designated mycetomas. Chalmers and Archibald have studied these conditions most carefully and have grouped most of them under maduro-mycoses and actinomycoses. The mycetomas are characterized by the presence of fungi in the form of grains composed of hyphae, and at times chlamydospores, imbedded in a matrix. These grains may be imbedded in the tissues or present in the discharge from the sinuses. Eosinophile bodies are usually present. The maduro-mycoses have grains with large segmented mycelial filaments, possessing well defined walls and usually chlamydospores. We have white or yellow, black and red ones according to the colour of the grains. The actinomycoses have very fine nonsegmented mycelial filaments with ill-defined walls and no chlamydospores. We have black, yellow and red grain actinomycoses. In addition to the mycetomas we recognize paramycetomas and pseudomycetomas, the former of which show fungi which do not show any grain formation and the latter failing to have present either fungi or eosinophile bodies. The pseudomycetomas are associated only by reason of clinical resemblance.
History and Geographical Distribution
History.—The disease was first described by Kaempfer about 200 years ago, but at that time was often confused with elephantiasis. The first exact clinical description of the disease, with its pathology, in which was noted the fungus nature of the granules given off in the discharges from the sinuses, was that of Vandyke Carter, whose studies were carried on from forty to fifty years ago.