KERATOMA PLANT A RE SULCATUM 



2259 



case in a European of good social standing. It improves or dis- 

 appears completely during the dry season. 



Symptomatology. — The epidermis of the soles — especially the 

 anterior portion — and the heels is greatly thickened, and is generally 

 of a dark yellowish colour, and presents numerous deep segmentary 

 furrows, straight, semicircular, or elhpsoid; these furrows appear 

 black, but if the dirt and' dust accumulated in them is removed, the 

 fundus of these sulci' will be found to be whitish or pinkish. There 

 is no sign of any local inflammation, though the patient generally 

 complains of tenderness'of the feet after much walking. 



Diagnosis. — This js jbased on the presence of the characteristic 

 deep sulci and ,punc'hed-out holes in' the thickened epidermis, which 

 are absent iv. fesions of the soles of the feet of syphilitic 'origin. 



Fig. 886.— Keratoma Plantare Sulcatum. 



Moreover, a mercury and potassium iodide treatment has no effect 

 whatever on the malady. In yaws the lesions of the soles of the 

 feet are, generally, either granulomatous, with large frambcesiform 

 nodules piercing through the thick epidermis, or a diffuse scaly 

 condition with thickened epidermis is observed. The rare pitted 

 condition of the soles of the feet (p. 1550) found in yaws is d^istin- 

 guished by its lack of seasonal incidence and by the history. In 

 the condition known as ' symmetrical keratodermia of the ex- 

 tremities ' no deep sulci are found. The so-called ' mal de meleda/ 

 which is very common in the Island of Meleda in the Adriatic, is, 

 according to Neumann and others, identical with symmetrical kera- 

 todermia, and no deep sulci are present. 



Prognosis. — The general health is not affected, but the condition 



