There is yet, in a pathological point of view, anotherl
and a very important stage in the course of syphiliSf J
and this ia characterised by the formation of certain pecn^j



OBDINARV C01IK8E AND STMPTOBS 25

liar local growthB, termed gnmmatoua tumoars or gnm-
mata. These may occur in auy organ of tbe body, ajid
are sometimeB diffused, and sometimes distinctly circum-
scribed. They are seen in their most perfect condition in
the liver, where their colour distinguishes them from the
strnctares in which they are embedded, but the skin,
mucous meuibranes, tbe bones, the brain, and all the
internal organs, may be the seat of these growths. They
are for the mo-st part peculiar to the later stages of syphi-
lis, and they differ from the more superBcial lesions of the
earlier stages in exhibiting a slowness of evolution, a power
of extension to all parts of the body, and a very decided
tendency towards disintegration and molecular necrosis
rather than towards spontaneous absorption and disappear-
ance. Some believe that gummata are purely local forma-
tions and are developed from deposits left over from
the stage of esanthematous eruption. In the more super-
ficial parts, viz. in the skin and subcutaneous cellular
tissne^ the disintegration of the gammata often gives riflti
to ulceration of a very destructive character and tending
to involve the adjacent parts. These ulcers sometimes
take a serpiginous course, extending in one or more
directions, while cicatrisation takes place at the spot where
the process commenced. When these formations take
place in internal organs, they often give rise to very serious
symptoms. Cerebral lesions, of a fatal character, are often
dne to the development of gummata. Similar formations
in the bones and periosteum are frequent causes of exten-
sive caries and necrosis, which in their turn set up a
marked condition of cachexia, associated with amyloid
degeneration of many internal organ.s, and especially of
the kidneys. A new train of symptoms is then presented.
