The _integuments_ nearly always participate in the changes, and are necessarily augmented in extent where covering the enlarged bones. The derm does not appear to be much altered in structure, but Eve found in the skin over the hypertrophied sole a thinning of the rete with almost complete obliteration of papillæ and enormous thickening of the fibrous tissues and inter-fascicular lymph spaces; but these changes were probably due to the abnormal pressure and friction to which the part was exposed. The subcutaneous adipose layer commonly shows a diffuse thickening, and in addition may undergo a circumscribed hypertrophy in the form of large lipomatous pads, which are mostly found upon the flexor aspect of the member affected, and correspond in situation and extent to the bony enlargement (Fig. 18); but the papillary and epithelial layers do not undergo any sensible changes, nor, as a rule, are the hairs or sebaceous follicles more developed than on the opposite side. The nails of hypertrophied digits generally undergo proportionate development. The secretion of perspiration is seldom altered in amount or character, but in a case of Wittelshöfer the patient complained of profuse sweating from the affected limb. The cutaneous sensibility is variously described as unaffected or diminished, never increased. A reduction of the sensibility to heat and pain was found to accompany the tactile defect in von Fischer’s case, and it is probable, as he suggests, that careful examination would generally reveal an impairment of the faculties. Pain is rarely complained of. Burning pain was present in association with trophic ulceration in a case of von Fischer, and pains of a rheumatic character appeared in the author’s case, but this symptom probably formed no part of the original disease. The _temperature_ of the part is generally normal. By exception, a rise of 2°-2½° Fahr., of 2°-6° Fahr. (Reid), 2°-4° Fahr. (Finlayson), and of ½°-1° Cent. (Trelat and Monod) has been recorded. _Pathological complications_ are rarely met with. Trophic ulceration appeared in a case of von Fischer’s; and in Friedberg’s case an eruption resembling pemphigus was noted, but probably was not directly connected with the congenital hypertrophy. Inflammatory crises, corresponding to those of elephantiasis Arabum, have been seen in only one instance, and in this the condition appeared to be complicated by true elephantiasis. _Associated defects of development_ are frequent in connection with makrodactyly. They may consist of multiplication, dwarfing, absence, or fusion of parts. The most common defect is syndactyly. Secondary distortions of the spine are found, however, when the hypertrophy of a single limb is very great. The general health does not appear to be affected by the condition.