SYPHILITIC GUMMATA. 383 



lation-growths " (Grannlationsgewachse). Notwithstanding tliis, 

 no one would dream of simply including them among the 

 products of inflammation ; at the very least, they would be 

 called " specific " inflammations. Their specific character does 

 not however reside exclusively in their etiological relations ; it is 

 also based on demonstrable anatomical peculiarities. The very 

 way in which the embryonic tissue is brought together deserves 

 special notice. It takes the form of nodular (tuberous) deposits 

 in the connective tissue of the cutis. The individual nodules 

 attain the size of a pea, or even that of a cherry or more. This 

 would of itself be a phenomenon of extreme rarity in the history 

 of simple inflammatory growth ; it would rather deserve to be 

 termed ^^sarcomatous." Still more important is the way in 

 icJiich the growth lingers on the confines between organisation and 

 decay. By slow gradations — it would seem — the embryonic 

 tissue passes, either into connective tissue, or into pus ; or 

 its cells become fatty wdiile its intercellular substance under- 

 goes mucous softening. We get a series of very charac- 

 teristic intermediate forms, of which we appreciate the value 

 when we attempt to distinguish between the individual members 

 of the group. 



§ 324. The syphilitic gumma has been fully described 

 elsewhere. The chief anatomical criterion of its specific charac- 

 ter was found to reside in the partial fatty degeneration of the 

 granulation-tissue, in the production of cheesy centres amid a con- 

 tinuous accumulation of newly-formed connective tissue. The 

 gummatous deposit in the skin deviates from this type in the 

 greater rapidity of its course, and in several other points also. 

 Gummata of the skin are rarely single ; they are usually 

 multiple, arranged in groups which occupy a certain tract of the 

 cutaneous surface {Lupus syphiliticus). The nodules are seated 

 in the parenchyma of the cutis, and even when they cause no 

 visible projection, they may be detected all the more readily by 

 the finger. The peculiar hardness which characterises them at 

 first, speedily passes, as a rule, into the opposite extreme. The 

 tendency of the cutaneous gumma to undergo softening, is well 

 known. This end is reached by the co-operation of suppuration 

 with fatty degeneration ; in this case, as in many others, they 

 fonii links in one chain, suppuration freeing the cells from their 

 organic connexion, while fatty degeneration indicates the imme- 



