Licence: Public Domain Mark
Credit: A system of medicine / by many writers. Source: Wellcome Collection.
Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)
34/944 (page 10)
![(fS) Gumma of M%isde.—This condition, according to Lewin, occurs at a later period after the primary infection than the foregoing change, in one case as long as thirty years. Morbid Anatomy.—The gummas of recent formation are not so sharply defined from the muscular tissue as those of longer standing. In the muscular tissue immediately around the gumma, the muscle-fibres are separated from one another by small-celled infiltration, and present a variable degree of atrophj^ The fibres retain for the most part their transverse striation and nuclei. In the older cases dense fibrous bands lie between the muscle-fibres. Symptoms.—The aftection is attended l)y very little pain, and the patient at first notices a hard swelling in the muscle, which is not tender on pressure, though some pain may be caused in the muscle when it is put into action. Out of 69 cases of muscle gumma collected by Lorenz the sterno-mastoid was affected in 26. In order of frequency other muscles were aff'ected as follows :' the quadriceps extensor, the muscles of the calf, the biceps, the forearm, the masseters, and the pectorals. The disease is sometimes symmetrical, being so in 3 out of 7 cases collected ])y Eger. The central portion of the muscles is that which is most commonly aff'ected. The presence of the tumour may give rise to very little disturbance of function in the muscles. The course of the disease depends largely on the time taken in the formation of the gumma. When growth is rapid and is met by antisyphilitic remedies recovery soon follows. On the other hand a tumour which forms slowly, disappears slowly, and may leave an indurated mass in the muscle. The tumour seen in the sterno-mastoid muscle of infants is by some regarded as a gumma, and probably correctly so in a small proportion of the cases. In these cases the tumour is not noticed at birth, but has been seen to appear in the first few weeks of life. Treatment.—The treatment of both these conditions consists in mercurial inunction and the administration of iodides. During the more acute stages of the disease the limbs should be kept at rest. In the later stages massage and passive movement may be used. {e) Myositis due to Trichindla spiralis.—(See Vol. II Part II. p. 908.) E. Secondary Affections of Muscles.—{a) Myositis due to the Speeifie Fevers.—The changes occurring in muscles during the course of the specific fevers should be regarded as degenerative rather than as inflammatory; these changes have been especially found in the course of enteric fever, and they give rise to a dull, pale, fish-like appearance of the muscle. On microscopical examination the fibres are seen to be swollen and hyaline, the transverse striation having disappeared; this process usually affects some of the fibres only, the others retaining their striation. AVhen suppuration takes place in the muscle, the abscesses have been found to contain streptococci, staphylococci, and other micro-](https://iiif.wellcomecollection.org/image/b21274083_0034.jp2/full/800%2C/0/default.jpg)
