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676 Occasionally islands of active disease spring up in this scar tissue; but it is at the margin of the implicated patch that the special features of the affection are best observed. In a case of some standing there is found a large area of white or irregularly pigmented, perhaps excoriated, unsound, contracting, folded and dense cicatrix surrounded by a narrow, serpiginous, irregular border of nodulated, somewhat raised, red, glazed, delicately skinned or pinkish, superficially ulcerated or cracked new growth.

In the case of the female (Fig. 95) the disease may

Fig. 95.—Ulcerating granuloma of pudenda in the female.

extend into the vagina, over the labia, and along the flexures of the thighs. In the male it may spread over the penis, involve the glans, scrotum, and upper part of the thighs. In either sex it may spread in the course of years to the pubes, over the perineum, and into the rectum, the recto-vaginal septum in the female ultimately breaking down. At times a profuse watery discharge exudes and even drips from the surface of the new growth, soiling the clothes, soddening the skin, and emitting a peculiarly offensive odour. In this condition the disease, slowly extending, continues for years, giving rise