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duration under natural conditions. Intone case, however, the 

 tumours persisted for several months, and, although decreas- 

 ing in size, did not completely disappear even during the 

 winter. 



Clinical examination. — Typical tumours of several weeks' 

 duration are recognized by their situation, their tough 

 fibromatous nature, and by the appearance of small yellowish 

 points lying beneath the mucous membrane or the unpig- 

 mented epithelium or, if ulceration is present, in the floor of 

 the ulcer. They are found to be attached to and involving 

 the skin. Lesions of only several days to two or three weeks' 

 duration are more difficult of recognition, for they have not 

 developed the characteristic yellowish points. Ulceration has 

 rarely occurred at this stage. A history of a more or less 

 sudden appearance, without any evidence of injury or 

 bacterial infection, may help one in making a diagnosis. 



Macroscopic examination. — The tumours may be single 

 or multiple, and those of some weeks' duration are usually 

 ulcerated on the surface. • 



When situated on the glans penis they vary in size from 

 that of a pea to larger than that of a walnut. The largest 

 specimen examined measures 5 cm, in length, 2*5 cm. across 

 the broadest portion, and 2 cm. in depth. The tumours on 

 the sheath attain a greater size, one specimen measuring 

 6*5 cm. across the larger diameter, 4'5 cm. across the smaller 

 diameter, and 2 cm. in depth. Much smaller tumours, vary- 

 ing in size from that of a lentil to that of a pea, and showing 

 a single yellowish caseous area in the centre, are sometimes 

 seen, and are usually multiple. 



On section of a typical tumour of several weeks' duration 

 it is seen that the tissue is tough, firm, and fibrous, greyish 

 to pinkish in colour, and contains scattered throughout the 

 mass irregular, yellowish, caseous areas varying in size from 

 points just visible to the naked eye to areas about 1 mm. in 

 breadth by 4 or 5 mm. in length, or even larger. In tumours 

 from the penis these caseous areas lie closer to the urethral 

 than the external surface. 



At times these caseous areas may contain some calcareous 

 deposit. They may be situated closely together or scattered 

 sparsely throughout the tumour and, in the older lesions, 

 may be fairly easily enucleated. On enucleation it is seen 

 that in each individual lesion they have much the same con- 

 sistence and colour, but vary in form. Those from an older 

 lesion are irregular in shape, yellow in colour, and hard, often 

 presenting a branching appearance. 



The points of caseous tissue seen on a cross section are 

 found to be parts of a larger area. No transition between an 



