s to break down
early, forming a superficial ulcer. Superficial gummas are often
multiple.

The _deep_ or parenchymatous form varies in size from a hazel-nut to a
walnut, and feels like a hard body in the substance of the tongue.
The mucous membrane over the swelling is of normal colour, but is
usually devoid of papillae. The gumma may remain for months unchanged,
or may approach the surface, soften, and break down, leaving a deep,
ragged ulcer.

_Syphilitic ulcers and fissures_ are nearly always due to the
softening and breaking down of gummas. The ulcers have seldom the
typically rounded or serpiginous outline of gummatous ulcers on other
parts of the body. The base is ragged and unhealthy, and on it a
yellowish-grey slough resembling wash-leather may be seen. The edges
are steep, ragged, and often undermined, and the surrounding parts
thickened and indurated. The neighbouring glands are not usually
enlarged. The ulcer is extremely painful when irritated by food, hot
fluids, or spirits. If untreated, the sore may remain indolent and for
months show no sign either of spreading or healing, but at any time it
may become the seat of cancer.

Syphilitic fissures are met with as long, narrow, deep clefts, or as
stellate or sinous cracks in the substance of the tongue. After the
healing of these ulcers and fissures permanent furrows and depressed
scars remain.

_Treatment._--The tertiary manifestations of syphilis in the tongue
are treated on the same lines as other tertiary lesions. Locally, the
use of mouth-washes, such as chlorate of potash or black wash diluted
with lime-water, the insufflation of powdered iodoform and borax with
a small quantity of morphin, or the application of mercurial ointment
is useful. The sore must be thoroughly cleansed before these remedies
are applied.

NEW GROWTHS

#Carcinoma# is by far the most common form of new growth met with in
the tongue, and it is almost invariably a squamous epithelioma.

Epithelioma generally occurs between the ages of forty and sixty, and
attacks males oftener than females, in the proportion of about six to
one. Its development is favoured by any long-continued irritation,
such as the rubbing of the tongue against a carious tooth, an
ill-fitting tooth-plate, or the rough end of a short clay pipe,
particularly when such irritation leads to the formation of an ulcer.
Chronic superficial glossitis associated with leucoplakia, and
syphilitic fissures, ulcer