It has been claimed that each generation needs its own biographies of historical personages retold in its own terms. The dictum may hold true for medical problems as well. As we make inroads into an understanding of various idiopathic diseases, we may lose sight of the real continuation of infectious diseases, especially those that are not too common, too acute, or too easily thought of.
Fungal infections are among those not usually recognized. Some, like mycetoma, tend to be monoarticular, producing grotesque disfiguring swelling through which sinus tracts burrow. Actinomycetes are chiefly responsible, including Madurella, Phialophora verrucosa, and Allescheria, the last-named most often guilty of producing this disorder in the United States.1 The local introduction into the skin, chiefly in people working outside in hot areas, is probably responsible. Those who see many cases in tropical countries think of the diagnosis. The occasional occurrence in the temperate climates makes