k 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.

The _treatment_ consists in destroying the original papule by the actual
cautery, acid nitrate of mercury, or pure carbolic acid. The ulcers
sho