File:Syphilis - a treatise on etiology, pathology, diagnosis, prognosis, prophylaxis, and treatment (1921) (14586323778).jpg

Identifier: syphilistreatise00haze (find matches)
Title: Syphilis : a treatise on etiology, pathology, diagnosis, prognosis, prophylaxis, and treatment
Year: 1921 (1920s)
Authors: Hazen, H. H. (Henry Honeyman), b. 1879
Subjects: Syphilis Syphilis
Publisher: St. Louis : C.V. Mosby Co.
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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,so that a deep punched-out ulcer is formed. When the lesionruptures, a thick gummy fluid is discharged, and it is from thecharacter of this discharge that the name gumma is derived.If secondary infection occurs, the discharge may be franklypurulent. The resultant ulcer is usually characteristic: it iseither round, oval or kidney-shaped, deep, with the walls de-scending at right angles from the skin so that the namepunched-out is given. The base is covered by a thick tena-cious secretion. A number of other gummata are apt to arise LATE CUTANEOUS LESIONS 13D in the immediate neighborhood and the resulting ulceration may-then be very large, so that it may be many inches in diameter.Around the ulcer there is always an indurated area with a red-dish or purplish areola upon the skin. At times these lesionsare covered by crusts that vary considerably in thickness. Thesecrusts may be rupial, or they may be thin, when they are calledcrustaceous. In rare instances there may be proliferation of
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Fig. (j1 .—When a gumma breaks down a charactei-istic punched-out ulcer is formed.(Collection of Dr. Richard L. Sutton.J tissue so that a verrucose appearance results. These lesionseventually heal by the formation of granulation tissue in thebase, and the later development of a scar. As a result of thisscar formation there may be varying degrees of contracture.Gummata usually heal rather readily under proper antisyphiliticremedies. 140 SYPHILIS Before ulceration gummata must be distinguished from furun-cles, erythema nodosum and erythema induratum, more rarelyfrom neoplasms. From furuncles they may be differentiated bymilder inflammatory reactions, their slower course and the slightpain that they produce. In case of doubt, aspiration and theexamination of the contents may help to decide the question, asfuruncles contain polymorphonuclear leucocytes and gummatado not, unless secondarily infected. Erythema nodosum hasmultiple symmetrical nodes, usually upon the legs, that are fre- KAL

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