Quotation from: Manual of Surgery

Written by: Alexander Miles and Alexis Thomson


The life-history of an untreated gumma varies with its environment. When
protected from injury and irritation in the substance of an internal
organ such as the liver, it may become encapsulated by fibrous tissue,
and persist in this condition for an indefinite period, or it may be
absorbed and leave in its place a fibrous cicatrix. In the interior of a
long bone it may replace the rigid framework of the shaft to such an
extent as to lead to pathological fracture. If it is near the surface of
the body--as, for example, in the subcutaneous or submucous cellular
tissue, or in the periosteum of a superficial bone, such as the palate,
the skull, or the tibia--the tissue of which it is composed is apt to
undergo necrosis, in which the overlying skin or mucous membrane
frequently participates, the result being an ulcer--the tertiary
syphilitic ulcer (Figs. 40 and 41).

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