[Reprinted from The Medical News, February 2, 1895.3 
A CASE OF LATE SYPHILIS SHOWING UNUSUAL 
LESIONS OF THE SKIN. 
By J. ABBOTT CANTRELL, M.D., 
OF PHIL" 
PROFESSOR OF DISEASES OF THE SKIN IN THE PHILADELPHIA POLY- 
CLINIC AND COLLEGE FOR GRADUATES IN MEDICINE, DERMA- 
TOLOGIST TO THE PHILADELPHIA HOSPITAL AND TO 
THE SOUTHERN DISPENSARY. 
The appearance of syphilis of the skin, especially 
when this occurs in the later stages of the disease, the so- 
called tertiary period, is likely to be manifested so often 
in very peculiar or even grotesque forms that it is just as 
likely to resemble some other disease of the skin as the 
one that has been the real cause of its appearance, and 
so much does this affection vary that I believe the record 
of such a case will be appreciated. 
The patient, a female, forty years of age, presented 
herself for treatment at my dispensary service, at the 
Philadelphia Polyclinic, on the 27th day of March, 1894. 
She stated that the eruption had existed for the previous 
seven years, and that it gave her no trouble other than 
by its appearance. Her family history, as well as her 
own personal history, seemed to be very fair, and she, 
furthermore, did not remember ever having had the 
initial lesion of the disease. The woman was married 
at the age of twenty-three years, and is the mother of three 
living and healthy children, all of whom have remained 
in good health to the present day. Their ages are four- 
teen, twelve, and nine years respectively. She further- 
more affirmed that she had never miscarried, and that 2 
the previous births were all natural in delivery, and that 
she had had no trouble after the births. 
The lesions, nine in number, were situated on the ex- 
tensor surface of the right forearm, and scattered at irreg- 
ular intervals between the elbow and three inches above 
the wrist. At the examination the arm was placed with 
the elbow in the patient's left hand, and the hand of the 
affected arm at the right shoulder. The first lesion to 
be described was three inches from the wrist, and was 
situated with the median line of the forearm running 
through its center, the lesion extending to within about 
three-quarters of an inch of either border of the forearm, 
measuring in itself from one end to the other about one- 
and-one-half inches, and was shaped like a sickle, the 
blade being toward the radial side of the forearm, and 
about one and-one-half inches long on the curve of its 
upper border, and from one-eighth to one-quarter of an 
inch wide. The "handle" was on the ulnar side, and 
about three-quarters of an inch long, and from one- 
quarter to three-eighths of an inch in width, taking a 
downward course toward the inner border of the fore- 
arm. At the highest point of the curved portion a fissure 
ran directly across the lesion, from which a slight dis- 
charge of pus was noticeable; the borders of the fissure 
were irregular. 
The second lesion was directly below the first, with 
about one inch of healthy skin intervening. It was irreg- 
ularly crescent-shaped; measuring from the highest point 
to the lowest, it was about one inch in length, and one- 
eighth inch in width. Its lower half comprised the larger 
portion, being three-eighths of an inch in width and one- 
half inch in length across the forearm. From the ulnar 
side of this lower portion it took an upward course, curv- 
ing around toward the radial side for a distance of three- 
quarters of an inch, and was from one-eighth to five- 
sixteenths of an inch in breadth. 
The third lesion was circinate in character, and was 3 
diseased throughout, being one-half inch in diameter. It 
was located on the radial side of the forearm, and about 
one-half an inch from the median line, and one inch from 
the outer border of the forearm. 
The fourth lesion was parallel with the third, and was 
the largest and most irregularly shaped of all. It began 
at a point marking the radial side of the forearm and 
about five inches from the elbow, running diametrically 
toward the wrist for about three-eighths of an inch, and 
being from one-sixteenth to about one-eighth of an inch 
wide. At this point it widened out and ran horizontally 
across the forearm for about one-and-five-eighths of an 
inch, being three-eighths of an inch wide at the begin- 
ning of the latter portion (at which point was situated a 
large tubercle, fissured horizontally) and abruptly dimin- 
ishing in breadth to from one-eighth to one-quarter inch 
for its entire remaining length. At the point ending the 
described portion, which was one-quarter inch from the 
border of the forearm, the lesion extended obliquely 
downward and inward toward the median line of the fore- 
arm for a length of one-and-one-eighth of an inch, then 
turned upward and pursued its course obliquely toward the 
median line for five-eighths of an inch to within one-half 
inch of its beginning point. The tissue was seemingly 
healthy and almost enclosed within the described lesion. 
The fifth lesion, which was pear-shaped, and lying 
horizontally, with the apex toward the median line, was 
two inches below the third lesion and three-quarters of 
an inch from the median line. It consisted of two tuber- 
cles, one five-eighths of an inch in diameter, ovoid in 
shape, and one one-quarter of an inch in diameter and 
circinate; they were joined together, the smaller one 
being toward the median line. 
The sixth lesion was one-quarter inch from the head 
of the ulna, and the same distance from the outer border 
of the forearm, its lower edge being parallel with the 
center of the head of the ulnar, and somewhat semi- 4 
circular in shape. The point nearest the ulna consisted 
of one large tubercle, ovoid in form, and about three- 
eighths of an inch long. From the lower part of this 
tubercle it curved outward, upward, and inward for a dis- 
tance of about one inch, forming the remainder of the 
semi-circle and being one-eighth of an inch in width and 
quite irregular in form. 
The seventh, eighth, and ninth lesions were on the 
ulnar side of the forearm and slightly above the elbow, 
and one-quarter of an inch from the outer side. They 
were discrete, although the lesion nearest the inner side 
of the arm was apparently made up of two lesions that 
had coalesced. These three lesions were each in itself 
a tubercle varying from one-eighth to one-quarter of an 
inch in diameter.