SYPHILITIC ULCERATION. 391 



as a grayish nodule ; soon it becomes yellowish from rapidly 

 advancing caseation, and finally breaks down completely. 



The resulting ulcer generally involves the muscularis ; its 

 floor is rough and nodular, from the presence of small tuber- 

 cles, which can be seen beneath the serosa externally (Fig. 

 182). The ulcers at first resemble somewhat those of 



FIG. 182. 



Tubercular ulcer of the intestine (Kaufmann). The cavity of the ulcer was formed 

 through disintegration and removal of the cheesy matter formed in the earlier 

 tubercles. Now the base of the ulcer is formed by necrosed and cheesy ma- 

 terial, beneath which eight or nine distinct tubercles are distinguishable, those 

 in the centre extending into the muscular coat of the intestine. The infection 

 has also extended into the lymphatics beneath the serous coat, where three 

 tubercles can be seen. 



typhoid fever ; but soon, as the result of breaking down of 

 other newly-forming tubercles at their margins, the ulceration 

 extends beyond the limits of the lymphoid tissue, no longer 

 conforming to the size and shape of these structures. Fresh 

 tubercles being formed in this way along the line of the lym- 

 phatic vessels, which run toward the mesentery, the long axis 

 of the ulcer becomes transverse, a complete ring of mucous 

 membrane being destroyed, in some cases, in this manner 

 annular ulcer. The border of the ulcer, like its base, is infil- 

 trated here and there with small tubercular nodules. On the 

 external serous surface radiating lines are noted, extending 

 from the base of the ulcer around the intestine toward the 

 mesentery, marking the tubercular infiltration of the subserous 

 lymphatics. Perforation is rare, owing to this infiltration and 

 thickening of the tissues. The corresponding mesenteric 

 glands are generally affected. If the ulcer heals, which is 

 infrequent, a puckered scar and possibly cicatricial deformities 

 remain. 



Microscopically -, the characteristic feature is the presence of 

 small tubercles in the floor and walls of the ulcer. 



Syphilitic ulceration of the solitary follicles and Fever's 

 patches of the small intestine sometimes occurs in infants. 



