I550 



FRAMBCESIA TROPICA 



the latter period of the secondary stage peculiar roundish or irregu- 

 larly outlined whitish patches are present, especially on the back 

 and arms, with a nutmeg-grater-like surface. On closer observa- 

 tion these patches are seen to consist of numerous hard, conical 

 papules, containing in their centre an epidermic plug, which is 

 easily removed, leaving a depression in the papules. Sometimes 

 the plugs are spiny, and in this case the eruption closely resembles 

 lichen spinulosus. 



Eruptions on the Palms and Soles.- — The granulomatous 

 eruption very frequently attacks the soles of the feet. At first 

 dark brownish or intensely livid spots appear; the thick epidermis 

 is gradually pierced by framboesial nodules similar to those found 

 in other regions of the body. This affection of the soles is very 

 painful; the natives of Ceylon call it ' dumas.' Similar lesions may 



Fig. 698.— Frambcesia: Pitted Appearance of the Hands. 



occur on the hands. The granulomatous infiltration may attack 

 the matrix and margins of the nails (framboetic onychia and par- 

 onychia). The nails become thickened, dry, brittle, and may be 

 cast off entirely, though later they grow again. 



After the granulomata have disappeared, occasionally at the 

 same time peeling, whitish patches may be seen on the palms of 

 the hands and soles of the feet closely resembling the syphilitic 

 psoriasis palmaris and plantaris. 



Peculiar Pitted Frambgeside of the Palms of the Hands.— 

 In several cases in the latter part of the secondary stage hard, round, 

 flattened papules or small nodules, having a thick, hard, epidermic 

 plug in their centre, may be observed on the palms and wrists. This 

 plug falls off spontaneously or is easily pulled out, when a deep 

 depression remains. The papules gradually disappear, but the de- 



