J 54 
they never are, they would probably show a firm white mammillated 
surface, like the head of a raw cauliflower, to sight and touch. 
A very striking feature, and one that marks them off at once 
from malignant growths, is the way in which they are confined to 
the skin, and hardly ever affect even the most superficial tendons. 
An extensive growth on the dorsum of the foot scarcely affected 
the movement of the extensors of the toes. And it is quite easy, 
after running an incision round them, to strip them like a scalp 
off the deep fascia, leaving a smooth surface on which grafts take 
readily. 
An exception to this was Case VIII, in which the growth 
situated on the inner side of the elbow, had enveloped the ulnar 
nerve and invaded the internal condyle for a short distance. But 
tins growth had been present for ten years, and the ulnar nerve, 
which ran through it much as the spinal accessory runs through 
tubercular glands, was easily freed, and covered with a skin 
graft. It. retained its motor and sensory functions unimpaired. 
L he fact that the growth could completely surround a nerve for a 
distance of some two inches for a period of several years, and leave 
it functionally active and sufficiently-' well nourished to take a skin 
giaft on its surface, is very good evidence of its sharp limitation 
and innocent character. 
II. FLAT FORM 
So far we have only seen two instances of this variety as against 
ei* it of the preceding. I hey both occurred in students of the 
ng ler schools, one on the face and one on the forearm, and had 
oeen present for four and twelve months respectively. 
ppearancc they were flat pink patches, raised one or two 
mi imetres above the surrounding healthy skin, covered with thin 
epi emus, sharply limited, painless, soft^ and freely moveable on 
the deeper structures. 
I heir essential identity with the preceding form is suggested 
. ^ cor, tained similar intracellular parasites. It 
is possi e that the apparent differences are due to external causes. 
t ese cases were in men of the educated class, who kept the 
growths clean and protected from irritation. It is possible that, if 
