Gumma of the penis.

Gumma of the penis is generally regarded as a rare condition and on that account it is likely to be overlooked as a possibility in the diagnosis of penile sores. As far as we can ascertain only eleven cases of penile gummata have been reported in the world literature during the past 40 years. In many of these cases the diagnosis was made on clinical grounds and not substantiated by histological proof. Berdal (1902) described two types of gumma of the penis, one being a classical gumma and the other a "tuberculoid" type. Fournier (1906) also described two types: a typical gumma, and a diffuse gummatous infiltration. He further subdivided the diffuse gummatous infiltration into a "sclerogommeuse" type, which was probably similar to Berdal's "tuberculoid" type, and a "forme scl6reuse" which often involved the urethra and caused a generalized fibrosis throughout the penis. Wise (1918, 1919) demonstrated two cases in which the diagnosis was made on clinical grounds. Mariantschik (1929) and Koyosu (1929) each described a case of this condition. Hahn (1947) reported a case in which treatment with arsenic and bismuth had been given 10 years previously for a penile sore which healed satisfactorily, but in which an ulcer had now appeared at the same site. This ulcer failed to respond to penicillin, but finally healed after a course of injections of arsenoxide and bismuth. Schmidt, Jaramillo, and Donghi (1950) reported one case, and Chapuis, Cole, and Duperrat (1954) reported two cases with gummata occurring at the site of the original chancre. In all three cases the diagnosis was confirmed microscopically. The present series comprises five cases of gumma of the penis, which have been treated recently at three London teaching hospitals. Three of the patients attended the Whitechapel Clinic, London Hospital, one St. Thomas's Hospital, and one St. Bartholomew's Hospital. One patient also had a gumma of the lung. Four of the five patients gave no history of primary or secondary lesions, and in