FEVER. 



267 



FIG. 107. 



Syphilis. 



The lesion which places syphilis among the infective granu- 

 lomata is the gumma, which occurs in the late or tertiary stage 

 of the disease. 



Though the cause of the disease is not definitely determined, 

 no one doubts the living nature of the contagium. 



The gumma occurs in almost all the tissues of the body, 

 most frequently, however, in the skin and subcutaneous cellu- 

 lar tissue ; in bone (tibia, sternum, and skull) ; in the brain 

 and its membranes (less frequently in the spinal cord) ; and in 

 the liver, kidneys, and lungs. It presents as a firm yellowish 

 white nodular mass varying in size from that of a hemp-seed 

 to that of an apple. On section it 

 has a gelatinous or gummy appear- 

 ance. The centre is often yellow 

 and cheesy from the necrosis it is 

 prone to undergo. If the nodule 

 is superficially situated, this necrotic 

 softening frequently results in the 

 formation of deep excavated ulcers. 



Microscopically the gumma is 

 composed of migrated leukocytes 

 and proliferating connective-tissue 

 cells of various forms. Epithelioid 

 and giant-cells are less frequently 

 seen than in tuberculosis. If casea- 

 tion has begun, in the centre is 

 found an opaque, homogeneous, and 

 granular material. At the periphery there is a vascular 

 newly-forming connective tissue (Fig. 107). 



Leprosy, glanders, actinomycosis, and rhinoscleroma are also 

 characterized by the formation of nodular masses of granula- 

 tion-like tissue. 



FEVER. 



Accompanying inflammation there is often very consider- 

 able constitutional disturbance. The body-temperature may 

 be elevated ; the pulse and respirations accelerated ; glandular 

 secretions, altered ; metabolism disturbed ; definite anatomical 



Gummy growth from liver, a, 

 central portions of growth, 

 consisting of granular debris ; 

 6, peripheral granulation-tis- 

 sue ; r, a bloodvessel. X 100 

 (Cornil and Ranvier). 



