extent and severity of his syphilis by the presence or absence of a
"breaking out" is just the one to think himself well for ten or twenty
years because his skin is clean, and then to wake up some fine morning
to find that he cannot keep his feet because his concealed syphilis is
beginning to affect his nervous system.

+Nature of the Tissue Change in Late Syphilis--Gummatous
Infiltration.+--The essential happening in late syphilis is that body
tissue in which the germs are present is replaced by an abnormal tissue,
not unlike a tumor growth. The process is usually painless. This
material is shoddy, so to speak, and goes to pieces soon after it grows.
The shoddy tissue is called "gummatous infiltration," and the tumor, if
one is formed, is called a "gumma." The syphilitic process at the edge
of the gumma shuts off the blood supply and the tissue dies, as a finger
would if a tight band were wound around it, cutting off the blood
supply. Gumma can develop almost anywhere, and where it does, there is a
loss of tissue that can be replaced only by a scar. In this way gummas
can eat holes in bone, or leave ulcerating sores in the skin where the
gumma formed and died, or take the roof out of a mouth, or weaken the
wall of a blood-vessel so that it bulges and bursts. The sunken noses
and roofless mouths are usually syphilitic--yet if they are recognized
in time and put under treatment, all these horrible things yield as by
magic. There are few greater satisfactions open to the physician than to
see a tertiary sore which has refused to heal for months or years
disappear under the influence of mercury and iodids within a few weeks.
Still better, if treatment had been begun early in the disease, and
efficiently and completely carried out, none of these conditions need
ever have been.

+Destructive Effects of Late Syphilis.+--Late syphilis is, therefore,