, the
pigmentation and ulceration, the history, and not infrequently marks or
scars of former eruptions.

[Illustration: Fig. 59. Tubercular Syphiloderm.]

#Describe the gummatous eruption of syphilis.#

The _gummatous syphiloderm_ (_syphiloderma gummatosum_, _gumma_,
_syphiloma_) is usually a late manifestation, showing itself as one,
several or more painless or slightly painful, rounded or flat, more or
less circumscribed tumors; they are slightly raised, moderately firm,
and have their seat in the subcutaneous tissue. They tend to break down
and ulcerate.

The lesion begins usually as a pea-sized deposit or infiltration, and grows
slowly or rapidly; when fully developed it may be the size of a walnut,
or even larger. The overlying skin becomes gradually reddish. At first
firm, it is later soft and doughy. It may, even when well advanced,
disappear by absorption, but usually tends to break down, terminating in
a small or large, deep, punched-out ulcer.

[Illustration: Fig. 60. Tubercular Syphiloderm.]

#Does the gummatous syphiloderm invariably appear as a rounded
well-defined tumor?#

No. Exceptionally, instead of a well-defined tumor, it may appear as a
more or less diffused patch of infiltration, leading eventually to
extensive superficial or deep ulceration.

#From what formations is the gummatous syphiloderm to be differentiated?#

From furuncle, abscess, and sebaceous, fatty and fibroid tumors.

Attention to the origin, course, and behavior of the lesion, together
with a history, must all be considered in doubtful cases.

[Illustration: Fig. 61. Large Pustular Syphiloderm.]

#What is to be said in regard to the character and time of appearance of
the cutaneous manifestations of hereditary syphilis?#

In a great measure the cutaneous manifestations of hereditary syphilis
are essentially the same as observed in acquired syphilis. They are
usually noted to occur within the first three months of extra-uterine
life. The macular, papular, and bullous eruptions are most common.

#Describe these several cutaneous manifestations of hereditary syphilis.#

The _macular_ (erythematous) eruption begins as large or small, bright-
or dark-red macules, later presenting a ham or cafe-au-lait appearance.
At first they disappear upon pressure. The lesions are more or less
numerous, usually become confluent, especially about the folds of the
neck, about the genitalia and buttocks; in these regions resembl