circumscribed corneous accumulations, unproductive of subjective sensations. These grain-like masses may be dug with the point of a knife from their bed, usually without the production of pain. The pits thus left in the epidermis may be first seen by the practitioner, representing then the several sites whence, by accident or intentionally, the minute corn-like masses have been removed. There may be few or many of such minute lesions in the palm; in the latter event the organ comes to resemble in a high degree the site of a symmetrical palmar and plantar keratosis, a disorder wholly unconnected with the syphilitic process.

In all the squamous syphilodermata of the palmar and plantar regions there are two features never to be ignored by the diagnostician. The first is the palpable fact that all the scales in these regions are sequences of abortive or developed infiltrations, papules, or tubercles of the part. The second is that the tendency of the eruptions of syphilis to assume the outlines of a whole or a part of a circle is well displayed over the palm and sole. At times the circles are to be seen very perfectly outlined, in many small or large groups in a single palm; again, the entire diffused patch, made up of coalesced macules or flat papules, has a defined circular border, evident in its advance toward the wrist or the line of the fingers, sweeping toward the dorsum of hand or foot, or well exhibited in the lines drawn between the web of the fingers or running over the hypothenar eminence. An example of this tendency may be conspicuous in the thinner integument of the inner face of the arch of the foot, where a circlet can often be discerned extending from exceedingly dense corneous plates of the sole.

Diagnosis.-Eczema of the hands and the feet usually involves the dorsum, or, if the sole or the palm at all, only by extension to the latter from the former region. Eczema limited to the palms and the soles does, however, occur, but chiefly in adults whose organs are more

or less continually immersed in water, especially water charged with mineral constituents. Patients of this class are usually dyers, laundresses, bar-keepers, or men engaged at soda-water fountains. The infiltrated areas of eczema are never well defined save in eczema marginatum of this region; the involvement of the skin is much more uniform; there is apt to be pustulation and vesiculation; there is never, under any circumstances, ulceration, even when the eczematous fissures are most painful; and the itching is apt to be well marked. Psoriasis is said to be in very rare cases limited to the palms and the soles, but these exceptions are so few as simply to prove the rule. In any doubtful case the discovery of psoriatic patches on the scalp, the sacrum, the elbows, or the knees would determine the question. It has been said that syphilis of the palms and the soles is ever accompanied by some unexpected lesion elsewhere, and it is often true that a mucous patch in the mouth or, in advanced cases, an undeveloped gumma of the leg will reward the careful explorer for his pains.

Moist Papules.—(a) Mucous patches (Mucous plaques; Plaques muqueuses).—The patch which is seated upon the mucous membranes in syphilis is pathologically identical with the mucous plaque or the moist papule of the skin. In both cases the papule-which in the palm or the sole fails to become elevated, but flattens to the point of exhibiting merely a scaling and plane macule-shows, in the regions of moisture, of friction or apposition of contiguous surfaces, and of heat, merely an oval or circular, scarcely elevated lesion. Its summit either furnishes a mucoid secretion or displays a thin pellicle more or less firmly attached, representing a sodden epidermal plate not as yet loosened from its underlying attachments.

Moist papules of the skin in syphilis occur in regions where the conditions are similar to those of mucous membranes with respect to heat, moisture, and the apposition of surfaces, as between the breasts of women, between the nates, in the axillæ and the groins of fleshy

persons, and in the interdigital spaces. Here the lesions form flattened disks, slightly elevated above the general level, covered with a whitish or grayish pellicle, often slightly depressed in the centre, and looking not unlike one of the varieties of the soft corn. At times they have a reddish tint. They are generally moist, secreting a thin mucus which in warm weather and in the uncleanly has a fetid odor. These lesions are decidedly more common

in women than in men, and in the young adult rather than in the middle-aged. Occasionally they develop into large vegetating masses; at other times they ulcerate. Their secretion is highly contagious. There is no better illustration of the moist papule than the chancre of the mucous surface of the prepuce, which, having survived until general symptoms of systemic disease occur, undergoes a characteristic transformation in situ into a moist papule.

(b) Condylomata (Condylomata lata; Verruca acuminata; Moist wart; Venereal wart; Ger. Spizen Warzen). -Condylomata are simply moist papules which undergo a hyperplastic metamorphosis in consequence of the extremely favorable circumstances under which they develop. Thus, a recently infected, young, fleshy prostitute of the filthy class is exceedingly apt to dis

play lesions of this sort about the vulva and the perineum. There are two tolerably distinct types of this affection, namely, the flat condyloma and the pointed wart. Both occur in syphilitic subjects, but the former is seen only in that disease and is a distinct symptom of it; the latter is seen, when the conditions are favorable, not only in syphilis, but in other venereal diseases as well.

Condylomata are found in the regions favorable to the growth of all moist papules, but they are best seen about the anus, where they often encircle the anal orifice with broad flattened disks from the size of coins to that of the section of a large egg. They enlarge by the growth of the primary lesions and also by coalescence of the disks. They have a disgusting odor, they generally secrete a mucoid or even a puriform semi-fluid, and they are whitish both from this secretion and from the pellicle covering their broad surface. They are capable of self-multiplication, the lying of one disk against an exposed surface being at times sufficient to produce a similar lesion exactly at the point of contact. As distinguished from others of the syphilodermata, they are usually the seat of a tormenting pruritus.

The pointed wart occurs in the subjects of syphilis and also in those whose parts are bathed with blennorrhagic, leucorrhoeal, and other secretions not syphilitic. They are single, multiple, often exceedingly numerous, filiform, papilliform, or corymbiform, moist and pointed. lesions varying in size from a pin-point to that of a fist, and even in extreme cases very much larger, the large-sized masses being always compounded of many primary warts, the septa between which can be recognized dividing the compound mass into separate lobes. They are often smeared with mucus, after the removal of which can be seen their vivid red color, each separate apex being provided with a delicate tuft. They are often compared in appearance to the comb of a cock. They rarely occur in virgins, but at times they develop in pregnancy, disappearing, as a rule, after delivery. Cocci and bacilli