770 CHRONIC INFECTIOUS DISEASES. 



same disease. From microscopic examination of the soft tissue and 

 of the more solid and resisting masses, the points of which contain a 

 yellowish-white and very dry substance, Virchow has satisfied himself 

 that the conical or spindle-shaped contents of the cavities, resulting 

 from the loss of bone, consist of the specific neoplastic product of 

 syphilis, to which he gives the name of gummata even when it is not 

 soft, and which Wagner calls the syphiloma. 



VIIL Syphilitic Sarcocele. Syphilitic contagion sometimes gives 

 rise to an inflammation of the testicle, distinguishable from other 

 forms of orchitis by certain peculiarities, particularly by its seat, 

 and the tediousness of its course. The disease begins in the tunica 

 albuginea and its continuations, and induces a proliferation of young 

 cells and new connective tissue upon the interior of the tunic, and be- 

 tween the seminal tubules. Under the pressure caused by this tumor, 

 which afterward contracts and indurates, the proper substance of the 

 gland disappears. Besides this simple syphilitic orchitis, there is a 

 second form, distinguished by the formation of dry, whitish-yellow, 

 homogeneous nodules in the affected organ, in addition to the prolif- 

 eration of the albuginea. Virchow calls the former disease simple 

 syphilitic orchitis, and the latter, gummy orchitis. Wagner believes 

 that there is no essential difference between the nodular syphiloma, or 

 gummy tumor, and the diffuse syphiloma. According to his views, 

 the form first mentioned is the diffuse syphiloma, while the latter con- 

 stitutes the nodular syphiloma of the testicle. The symptoms of syphi- 

 litic sarcocele consist in a slowly-progressing enlargement of one or 

 both testicles, which develops either without any pain at all, or else is 

 accompanied by occasional lancinating twinges. The testicle becomes 

 very hard, loses its regular shape, and may grow to the size of a fist. 

 Sarcocele is often accompanied by a serous effusion in the tunica vagi- 

 nalis propria. Sometimes the disease, after making some progress in 

 one testicle, attacks the other. 



Virchow describes a syphilitic periorchitis : This may commence as a 

 hydrocele, but soon occasions thickening of the albuginea and tunica vag- 

 inalis propria, causing adhesions, or even complete synechia of the latter. 



IX. Syphilitic Disease of the Connective Tissue, Muscles, and 

 Viscera. In cases of inveterate syphilis, tumors presenting the char- 

 acteristics of the gummy tumor, or syphilitic tubercle, are also found in 

 the subcutaneous and submucous connective tissue, and in the inter- 

 stices of the muscles (Virchow). When properly treated, they 

 sometimes disappear, while at other times they suppurate, producing 

 abscesses and intractable ulcers. 



The muscles also, especially those of the upper extremity, the 

 throat and neck, are sometimes the seat of syphilitic disease. Virchow 



