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Updated: October 15, 2025
Then suddenly at the place where the injury was done a gumma or tertiary syphilitic change will take place and the bone refuses to heal or unite or a large sore may develop which may be operated on before the nature of the condition is realized.
#Diagnosis.# A cold abscess is to be diagnosed from a syphilitic gumma, a cyst, and from lipoma and other soft tumours. The differential diagnosis of these affections will be considered later; it is often made easier by recognising the presence of a lesion that is likely to cause a cold abscess, such as tuberculous disease of the spine or of the sacro-iliac joint.
Embedded bodies may remain in the tissues for an indefinite period without giving rise to inconvenience. At any time, however, they may cause trouble, either as a result of infective complications, or by inducing the formation of a mass of inflammatory tissue around them, which may simulate a gumma, a tuberculous focus, or a sarcoma.
If the heart is slowed as a whole, the trouble might be due to diseased arteries or pressure from a growth, a gumma, perhaps, or other brain tumor in the region of the pons Varolii or medulla oblongata; or a hemorrhage into the fourth ventricle, causing pressure, could be the cause. The treatment of true Stokes-Adams disease is unsuccessful.
After a variable period it usually softens in the centre, the skin over it becomes livid and dusky, and finally separates as a slough, exposing the tissue of the gumma, which sometimes appears as a mucoid, yellowish, honey-like substance, more frequently as a sodden, caseated tissue resembling wash-leather.
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.
A central gumma in a long bone may not reveal its presence until it erupts through the shell and reaches the periosteal surface or invades an adjacent joint. Sometimes the first manifestation is a fracture of the bone produced by slight violence. In radiograms the appearance of syphilitic bones is usually characteristic.
An isolated gumma forms a firm elastic swelling, shading off into the surroundings. If the overlying skin is destroyed and septic infection superadded, such an isolated area of bone is apt to die and furnish a sequestrum; the separation of the dead bone is extremely slow, partly from the want of vascularity in the sclerosed bone round about, and partly from the density of the sequestrum.
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