pletely eaten away so that it
looks as if it had been cut off with a knife. As the disease advances
there is severe pain and usually profuse salivation. The submaxillary
glands may be, but are not always, enlarged. The ulcer may heal, but
tends to break down again.

Unless there is advanced pulmonary disease or other contraindication
to operation, the ulcer should be excised under local anaesthesia. Care
must be taken to avoid reinfecting the raw surface. When excision is
impracticable, it is only possible to palliate the symptoms by dusting
with orthoform, or applying local anaesthetics, and by attending to the
hygiene of the mouth and removing all sources of irritation.

#Syphilitic Affections.#--A _primary lesion_ on the tongue is
accompanied by marked enlargement and tenderness of the submaxillary
lymph glands on one or on both sides. It is most common in men,
infection usually taking place through the medium of tobacco pipes, or
implements such as the blow-pipes of glass-blowers.

During the _secondary stage_--particularly in the later
periods--mucous patches and ulcers are common, and they may assume a
condylomatous or warty appearance.

The _tertiary_ manifestations in the tongue are sclerosing glossitis,
gummas, and gummatous ulcers.

_Sclerosing glossitis_ is the term applied by Fournier to a condition
in which there is an abundant new formation of granulation tissue in
the substance of the tongue, leading to the appearance of tuberous
masses on the dorsum. These tend to be oval in outline, are elevated
above the normal mucous membrane, and present a dull red mammilated or
lobulated surface, comparable to the surface of a cirrhotic liver.
They are firm, elastic, and insensitive.

A _gumma_ is usually situated on the dorsum and more often towards the
centre than at the edges. As it seldom implicates the floor of the
mouth or the base of the tongue, the tongue can usually be protruded
freely. It forms an indolent swelling, which tends to break down
slowly and to ulcerate. So long as it remains unbroken it does not
cause pain, and there is no enlargement of the adjacent lymph glands.
Two forms are met with--the superficial, and the deep or
parenchymatous.

A _superficial_ gumma appears as a small hard nodule under the mucous
membrane, varying in size from a pin's head to a pea. The mucous
membrane over it is redder than normal, and in the early stages
retains its papillae but later becomes smooth. It tend