Page:A Handbook of the Theory and Practice of Medicine - Volume I - Frederick T. Roberts.djvu/292

27^ THEORY AND PRACTICE OF MEDICINE.

of the nature of fibro-plastic, fibro-nuclear, or fibroid tissue, which are very prone to suppuration or ulceration.

Many growths are met with in tertiary syphilis which merely re- sult from proliferation of ordinary connective or fibrous tissue, and which present the characters of this tissue, but those which are peculiar to syphilis constitute what are termed gummy tumours or gu77imaia ; there is, however, no marked line of demarcation between these two kinds of growths, both often existing; together, and the former becoming converted into the latter. Gummata are not of the nature of an exudation, but result from hyperplasia of the con- nective-tissue elements previously existing, this process beginning in the walls of the vessels, the new elements invading the normal tissues, and being mixed up with or displacing them. At first gummata are soft, translucent, greyish-white, and almost homo- geneous ; but afterwards they become firmer, tough, yellowish, opaque, non-vascular, and caseous-looking, owing to degenera- tion and gradual drying-up of their structure. On section they

often present a central yellowish mass, or several distinct yellow spots, surrounded by a translucent fibrous layer, which sometimes looks like a capsule, but this cannot be separated from the surround- ing tissues, into which it gradually passes. Gummata vary much in size, and some of the larger masses seem to be formed by the union of smaller no- dules. In structure they resemble at first granulation-tissue or embryonic connective-tissue, consisting of an a- morphous matrix, with minute spherical or ovoid finely-g'ranular cells, enclosing obscure nuclei. The matrix becomes fibrillated more or less ; while many of the young elements degenerate, and ultimately break down into mere granules of fat and cholesterin, which are imbedded in a small amount of fibrillated stroma. These several stages may be seen in the same growth, the central yellow- ish portion of the nodule being that which is most advanced in the process of degeneration. A few vessels are present in the recently- fo rmed tissue, but these subsequently disappear.

Syphilitic gummata maybe absorbed more or less completely; or their fibrous stroma may be left, which tends to shrink, giving rise to deep cicatrices or seams ; or in certain structures they are liable to suppurate or to ulcerate. Several tissues and organs are often implicated at the same time, this being one of the prominent cha- racteristics of syphilitic deposits.

The chief morbid conditions which are liable to be met with in tertiary syphilis may be enumerated as follows : — i. Skin-eruptions and ulcerations, viz., erythema and psoriasis of the hands and feet • or ulcerations originating in tubercles, subcutaneous gummata, or syphilitic lupus. These ulcers are of a horse- shoe or kidney-shape,

Fig. g.

Gummy groiiih of liver, a. Central portions of growth, consisting of granular debris, b. Peripheral gra- nulation tissue, r. A blood-vessel. X loo (After Cornil and Ranvicr).