1 5 5 
they had been situated on the bare and dirty limbs of fellaheen, 
exposed to constant friction and bacterial invasion, they might 
have shown the same proliferative changes which are so marked in 
the papillomatous form. 
The two cases recently described by Balfour* fall into this 
class, in which, in our experience, the parasites are present in much 
larger numbers. 
Treatment. A very large variety of lotions and ointments 
have been used for these growths. 1 hey seem to have no effect, 
beyond slightly diminishing the sepsis. 
In one case a determined attempt was made to treat a large 
patch by ionization with iodine. Lnder this treatment there %\as 
distinct improvement up to a certain point, and the size of the 
growth was measurably lessened; but after six weeks there was not 
enough change to make it worth while continuing. 
For fellaheen especially — who cannot aftord to spend a long 
time in hospital—the only treatment worth considering is that of 
excision of the whole mass, followed by immediate skin grafting. 
The growths can be readily stripped off the underlying fascia, and 
in spite of the sepsis usually present, grafts take fairly well. A 
good example of this is shown in PI. XIII, fig. b (Case V UN¬ 
CASES 
Case I. PI. XII, figs, i, 2. Man aged eighteen, admitted 
January 21, 1907, under Mr. Richards. Six weeks ago lie ha 
swelling of both legs; a few days later small red patches appeared, 
which increased in size and turned brown. 
On admission there is a brown circular raised patch, three inc les 
across, divided by irregular furrows containing a yellowish-brown 
secretion, situated in front of the ankle and extending back past 
the external malleolus. A similar one on the internal malleolus o 
the right leg, and a smaller one above it. Two more on the dorsum 
of the left foot. The patches have a foul smell, and are surroun 
V an inflamed area. There is a little oedema of both feet. 
* ‘Tians. Soc. Trop Med. and Hyg.,» Vol. III. No. 3 . P* lo '- J ani,ar - V ’ I9I °' 
