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If there has been a recent exposure to venereal infection, it is liable to be regarded as the primary lesion of a second attack of syphilis, but the further progress shows that neither bullet-buboes nor secondary manifestations develop. These facts, together with the disappearance of the induration under treatment, make it very likely that the lesion is really gummatous in character.
In cases of persistent or relapsing gummatous disease with ulceration of skin, it is often necessary to remove the diseased soft parts with the sharp spoon and scissors, and to gouge or chisel away the unhealthy bone, on the same lines as in tuberculous disease.
Gummatous disease is frequently observed also in the flat bones of the skull, in the bones of the hand, as syphilitic dactylitis, and in the bones of the forearm and leg. When the tibia is affected the disease is frequently bilateral, and may assume the form of gummatous ulcers and sinuses.
Mercury has as high a reputation and is as indispensable in the cure of syphilis today as it was four centuries ago. It has as yet no substitutes. We appreciate every day, more and more, how thoroughly it can be depended on to do the work we ask of it. It has a peculiar effect on gummatous tissue, causing it to melt away, so to speak, and greatly hastening the healing process.
Gummatous disease in glands is extremely rare; the affected gland rapidly enlarges to the size of a walnut, and may then persist for a long period without further change; if it breaks down, the overlying skin is destroyed and the caseated tissue of the gumma exposed.
On the inner surface of the skull, the formation of gummatous tissue may cause pressure on the brain and give rise to intense pain in the head, Jacksonian epilepsy, or paralysis, the symptoms varying with the seat and extent of the disease.
The shoddy tissue is called "gummatous infiltration," and the tumor, if one is formed, is called a "gumma." The syphilitic process at the edge of the gumma shuts off the blood supply and the tissue dies, as a finger would if a tight band were wound around it, cutting off the blood supply.
It is even possible to have the roof fall out of the mouth from gummatous changes and the Wassermann test yet be negative. It is equally possible, though unusual, for a negative Wassermann test to be coincident with contagious sores in the mouth or on the genitals. So it is apparent that as an infallible test for syphilis it is not an unqualified success.
In the septum of the nose, the nasal bones, and the hard palate, gummatous disease causes ulceration, which, beginning in the mucous membrane, spreads to the bones, and being complicated with septic infection leads to caries and necrosis. Syphilitic disease of the tibia may be taken as the type of the affection as it occurs in the long bones.
In exceptional cases the necrosis involves the entire vertical plate of the frontal bone. Gummatous disease in the wall of the orbit may cause displacement of the eye and paralysis of the ocular muscles. [Illustration: FIG.
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