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epidermis, and has a low-set warty cauliflower appearance. There 
is no ulceration. It is surrounded by a margin 1-3 cm. broad, in 
which the skin is raised, smooth and glistening with some loss of 
pigmentation. 
A similar oval patch 7 x 3 cm. is found over and behind the 
external malleolus. Movement of tendons unaffected. 
Left foot. A similar patch, 12 x ;> cm., covering base of four 
inner toes and adjacent dorsum. Another over tendo Achillis, 
6 x 4I cm., its lower margin level with malleoli. This has no cracks. 
Enlarged glands in groin on both sides. 
Pathological Note (A.R.F.) 
A case, in my opinion, of the same parasitic nature as the two 
others (I, II). The parasite may be:— a, a pathogenic yeast; b , a 
mycelial fungus, Botryomycosis. 
Treatment. All the growth was stripped off the right foot 
leaving a smooth grey surface, which was painted with iodine, an 
afterwards skin-grafted. It healed well, but in July small warty 
indurations began to form in the scar, suggesting recurrence. 
The left foot was treated by ionization with iodine. It decreased 
in circumference from 27 to 25 J cm., became painless an 
movements of the toes quite free. It then remained stationary. 
He was discharged at his own request, July 11 • 
Case IV. PI. XIII, fig- 5 - A man of 3 8 > admitted Apn 24, 
1909, under Dr. Day for cirrhosis and ascites. 
On the right hand is a growth extending over the metacarpals of 
the first three fingers, with a raised border. I he lesion was o a 
year’s duration. It presented itself as a circular area with a lirm, 
raised edge, which was rounded, covered with skin and painless 
Manipulation of the lesion was freely permitted, althoug ^ema 
said that it sometimes pained him at nights. e . , 
ulceration to speak of. The centre consisted of a thin, wr 
cicatrix, said to be due to cauterization. 1 he lesion ha com 
centrally, and extension had since been going on at t , 
Naked-eye section of the margin showed it to be composed of a 
solid white mass of epithelium, the processes o w 
