9 6 
the inside of the foot. The condition had persisted for seven months 
before the photographs were taken. 
The whole of the right leg from below the knee is swollen and 
hard, pitting on strong pressure ; the skin is tense, smooth, and glossy, 
and through the hair the superficial lymphatics and small vessels can 
be seen. Below the knee, on the outside, is a small, hard fibrous 
nodule the size of a large pea. The foot is greatly enlarged and a 
deep sulcus is formed by a fold at the back of the ankle joint. Along 
the lower part of the foot is a verrucoid growth, which covers the 
dorsal surface of the toes and part of the foot, and is well raised above 
the surface of the skin. The growth extends around the foot but does 
not involve the sole. The growth is more advanced along the outside 
than along the inside of the foot, and extends higher up. The 
appearance is as if the foot was covered with old dried moss. 
On the dorsal surface of the toes the growth appears as small, 
well-defined, but closely collected papillae, resembling a miniature 
forest of coarse points; these spring from a bed of thickened tissue, 
well raised above the surface of the skin. The growth covers the 
whole of the dorsal surface of the toes, extends and overhangs or 
surrounds the toe nails, but does not completely envelop them. The 
skin between the toes is free from all growth. The growth extends 
slightly further on to the second and third and little toes, but does not 
invade the plantar surface. The big toe has some old scars, where 
the growths have been burnt with caustic. 
The forest-like growth of warts extends towards the back of the 
oot for neatly 8 cm., and continues in a wavy outline across the foot. 
On the outside of the foot the ridge of the growth is more irregular, 
varying from 4 to 7 cm., and, at the back of the heel, from 3 to4cm- 
eep It does not cover the deep sulcus at the back of the os calcis. 
t e inside surface of the foot the outline is still more irregular, 
being from 2-5 to 6 cm. wide. 
he character of this growth alters on the sides and heel; in 
e evT77 m ° SS ~ like ’ the byp^phied patches of papillae 
.ndlvtuaf qU ! S ’ Tu 1 and honl y sodden epideLis. 
. : mersecT'rt P K° m T the , Pa P illae * defined, and the plaque: 
o t . y deCp Cracks or Azures. On the inside of the foo 
“ XT,:: it/ oTtt r ular r ses ' which project 
r the front of the foot are one or 
