— 629 
Egyptian fellah from the village of Nezli Bedeni in the Mudirieh of Minieh, 
Upper Egypt. He is stoutly built man, not very intelligent, in good condi¬ 
tion but not of such fine physique as is usually seen amongst the Egyptian 
soldiery. He has had five months’ service in the Egyptian Army, the last 
four months of which hâve been spent in the Sudan. 
Admitted to the Military Hospital, Khartoum, on october 9 th. with soft, 
pink, keloid-like raised growths on the face, neck, shoulders, arms, back and 
inner surface of the thigh. 
Family History. — Father, aged about 70, developed similar growths six 
years ago and at the présent time they are more numerous and much larger 
on his bodv than on that of his son. Since the growths appeared he has 
become a lunatic and has lost his hearing. The tumeurs are said to be in 
some instances many inches in diameter and hâve never showed any sign of 
ulcération or breaking clown. 
Mother dead, cause unknown. 
Brothers. One brother and one step-brother. Neither are affected. The 
former aged about 40 would appear to be phthisical. 
Sisters. Six in number and ail unaffected save one. Eldest aged about 35. 
Youngest about 12 years. The eldest sister is married and has three girls, 
ail healthy. The second sister has two children, a boy and a girl, both 
healthy, the third sister has one girl who is healthy but the mother has for 
the past 41/2 years suffered from the same skin disease as her brother. She 
became infected when living at home and in her case the tumours are 
about as numerous as in the brother’s. Her husband shows no sign of the 
disease. 
The fourth sister has one girl who is healthy. The two youngest sisters 
are unmarried. 
A paternal uncle died of phthisis four years ago. An aunt, aged 75, is 
healthy. Pa'tient’s grandparents are dead, cause of death unknown. 
Personal history. — As a child patient had small-pox. There is no history 
of any venereal complaint. No history could be obtained as regards the pré¬ 
sence of insect parasites in his house or village. 
History of présent illness. — The growths, which, as will be seen, occur 
for the most part in groups (fig. 2) began to appear first of ail upon the left side 
of the neck two years ago when he was living in his native village. Then the 
left side of the face became infected eight months ago, followed by the 
right shoulder and right upper arm six months ago. Four months ago the 
neoplasms appeared on the outer surface of the left forearm and fourteen 
days ago very small papules presented themselves on the inner surface of 
the left thigh about the région of Scarpas’ triangle. 
In addition growths, the date of appearance of which is uncertain, are 
présent over the insertion of the left deltoid and nearly in the centre of the 
back slightly to the left of the spinal column. 
The growths are said by the patient to appear first as small, pink, cir- 
cular points raised above the surface of the skin and of about the size of a 
pin’s head. They grow until they reach the size of a pea, when secondary 
points appear to develop at the peripherv of the primary growths and as a 
rule separated from these latter, by narrow tracts of healthy skin. These 
secondarv tumours develop and become absorbed into the parent growths. 
As a resuit the main tumours increase in size and the w r hole mass takes on 
an irregular shape. 
