Gumma of Muscle.

ALL modern authorities are agreed that gumma of muscle is now a relatively rare manifestation of syphilis. The condition is adequately described by Harrison and Lees who state that the triceps, biceps, sterno-mastoid, tongue, rectus abdominis and the calf muscles are most commonly involved. The gummata may retrogress and undergo calcification, or even ossification, or may break through the skin to form typical tertiary ulcers. Stokes believes the condition is quite rare and Haines, in reporting a case of gumma of the left rectus abdominis, considers epigastric hernia, sarcoma of the rectus sheath, Paget's recurring fibroma and lipoma and rhabdomyoma of the rectus muscle in the differential diagnosis. It is of interest to distinguish gumma of muscles, as described above, from subcutaneous gummata which may be multiple and symmetrical and affect the tendons in relation to the knee and elbow joints. This latter condition, which has been described by Lane, Wakeley, Piarkes, Weber, Goodman and Young and Wangensteen, is also uncommon and, in some of the cases described, trauma appears to be a precipitating factor in the break down of these subcutaneous gummata. The gumma of muscle usually responds rapidly to active anti-syphilitic treatment and it is therefore regrettable that the condition is often only recognised after surgical measures, following on a wrong diagnosis, have accelerated the tissue destruction. A useful purpose may therefore be served by recording the following example of gumma of the rectus abdominis although, in addition, the case presents other features of interest.