Gummatous (Tertiary) Syphilis

Ah, syphilis.  The disease that gave our specialty its foothold in modern medical consciousness, it was known variably as the Great Imitator, the Great Pox (as opposed to smallpox) and, depending on which side of the Channel you lived, either the English Disease or the French Disease.  Me?  I have both English and French friends, none of whom have had syphilis - to my knowledge- and so I must remain neutral.

Syphilis comes in four flavors:  Primary, Secondary, Latent and Tertiary.  A full discussion of the timing of these manifestations is available online, and so I won't belabor the subject, but in the case of tertiary syphilis, it tends to occur somewhere around fifteen years later, give or take.  

Gummatous syphilis is one of the tertiary manifestations of this spirochetal conundrum, as is neurosyphilis and cardiovascular syphilis.  The gummas often presented on non-skin tissue and were soft, granulomatous masses.  In the skin, they commonly became ulcerated as above.  The lesions started out as painless, progressed to mild tenderness but often then led to a gnawing, boring pain that was excruciating.  

Syphilis had a great hold on the 19th and early twentieth century mind.  Henrik Ibsen, Norway's most famous playwright, wrote a play Ghosts, about dysfunctional Norwegian society, with syphilis playing an allegorical role representing the moral rot of society.  Needless to say, it was quickly banned just about everywhere, thus cementing Norway's place as the Graveyard of Playwrights.

We will see syphilis again, because of its importance both in medicine and in medical history.