A gumma of sufficient size to attract attention is rarely encountered. Chiari observed only three instances in 243 necropsies upon persons suffering from syphilis, and in all about sixteen genuine examples are recorded in the literature of the subject. The tumour, which is often multiple, is usually situated in the submucous tissue of the pyloric region, near the lesser curvature. It is round and somewhat flattened on the surface, yellowish in colour, firm on section, and varies from three to seven centimetres or more in diameter. At first the mucous membrane which covers it is stretched and thin, but as the nodule increases in size and its substance undergoes softening it usually becomes destroyed and an ulcer is produced. A gummatous ulcer consequently presents certain features which serve to distinguish it from the simple variety. In shape it is often irregular, scalloped, or even triangular; its edges are thickened and undermined ; while its walls and base are shaggy, cheesy, haemorrhagic, or covered with a firmly adherent yellow slough. The mucous membrane in the vicinity of the neoplasm, or its resultant ulcer, exhibits signs of chronic inflammation and is not infrequently studded with minute gummata. Perforation of the stomach has not been observed, although in a case recorded by Lancereaux this accident was prevented only by the presence of a cheesy nodule. It is important to observe that in all these cases manifestations of syphilis were present in the other abdominal viscera, the liver, pancreas, spleen, or lymphatic glands presenting gummata or cicatrices. In cases of congenital syphilis in newly born infants the small intestine is particularly apt to suffer, and small gummata may often be found scattered throughout its length or congregated about the ileo-caecal valve. Similar conditions have also been described in the foetus (Bittner).