AN UNUSUAL 
CASE of syphilis; 
By A. H. Ohmanu-Dumesnil, A. M., M. D. 
Reprinted, from, the St. Louis Medical and Surgical Journal, June, 1886, 
The case, whose history I am about to relate, while not extra- 
ordinary by any means, is one which deviates considerably from 
what has been generally accepted as the type in this disease. 
Moreover, there is a sufficient number of interesting points pre- 
sented by it to render it worthy of being placed upon record. 
It may also serve to enlarge our views upon syphilis, to a limited 
degree, by the few interesting problems which it presents. The 
history of the case, in brief, is as follows: 
On Jan. 20th 1886, F. K 32 years of age, single, a native 
of Germany, painter by trade, came to see me for a venereal 
trouble. He stated that two weeks before, Jan 6th, he observed 
two “sores” upon his penis. Upon examination, I found two 
slightly elevated, eroded, superficial ulcers, each about the size of 
a silver quarter dollar. One was situated upon the integument, 
upon the dorsum penis, and the other upon the skin of the ven- 
tral portion of the organ. There was no pain connected with 
these lesions, except when exposed to too much friction from 
the clothing. The secretion was very scanty and somewhat 
purulent, although to a very slight degree only. The inguinal 
ganglia on each side were considerably enlarged, varying in size 
from a filbert to a half walnut, and somewhat tender to pressure. 
Upon careful inquiry, which has been repeated from lime to 
* Head before the Missouri State Medical Association, May 3rd, 1886. 2 
time, the fact was elicited that the last time the patient had con- 
nection was on Nov, 21st, 1885. 
No attempt at treatment was made beyond ordering an iodo- 
form dressing for the ulcers and their protection from friction. 
Feb. 1st 1886.- The patient having been instructed to return 
as soon as an eruption should make its appearance, came and, 
upon examination, disclosed a well-marked roseola, distributed 
over the chest, abdomen, upper portions of the arms, and back. 
He complained also of headache and rheumatic pains. He was 
ordered an eighth of a grain of bichloride of mercury three 
times daily and applications of mercurial ointment twice daily 
to the chancres and indurated ganglia. 
Feb. 9th. He reappeared, complaining of pains thoughoutthe 
body, but more marked in the bones. There was also anorexia 
and some fever. Small papules had also made their appearance 
in the meantime. An eighth grain of bichloride was ordered to 
be taken five times daily, and locally the application of oleate of 
mercury, of ten per cent strength, twice a day. This treatment 
was continued until the 24th of February, at which time the 
metallic taste was well-developed as well as the fetor of the 
breath. The eruption had all disappeared and the chancres 
healed, whilst the ganglia in the groins were almost entirely 
reduced to their normal size. A rest of about ten days was or- 
dered, during which external applications, only, were to be 
made. 
March 8th. The patient presented himself with marked iritis 
of both eyes. He was ordered an eighth grain of corrosive 
sublimate four times daily and sent to Dr. C. Barck, to have his 
eyes attended to. For the latter he was ordered oleate of mer- 
cury and belladonna ointment, to be rubbed over the forehead, 
and atropine solution to be dropped into the eyes. 
March 15th. The eyes had not improved. Upon close ex- 
amination the cause of the iritis was found to lie in seven small 
tumors, three in one iris and four in the other,—each one a 
little larger than the head of a pin, of a greyish color and un- 
doubtedly gummata of the iris. In this diagnosis Dr. Barck 
concurred. Noting the necessity of thorough mercurialization, 
mercurial inunctions were ordered and the patient faithfully 
followed directions. 
March 21st. The eyes were not so painful, the patient saying 
that they were better. He was told to continue the inunctions 3 
and to use about one and a half drachms for each application. 
March 24th. The eyes were worse. The photophobia was 
well-marked and hypodermic injections of mercury were re- 
solved upon. 
March 25th. Six minims of the following were injected : 
Hydrargyri bicyanidi 0.22 ( gr. 3) 
Aquae Destillatae 40.00 ( 3x) 
M. ft. sol. 
Injections were then given daily, varying in amount from 
ten to fifteen minims, until on April 9th the thirteenth injection 
had been given. During all this time the mercurial inunctions 
were kept up. 
April 9th. The eyes are much better and the patient says 
that there is no pain whatever in them: he feels well. 
On April 4th a mild stomatitis had developed, for which a 
wash, containing tincture of myrrh, was prescribed, together with 
the frequent rinsing of the mouth with a weak solution of alum. 
This he was ordered to continue and it prevented further mani- 
festations of the action of the mercury upon the mucous mem- 
brane of the mouth. 
April 13th. The patient reported and examination re- 
vealed the fact that the improvement in the eyes was marked. 
He was ordered one-eighth grain corrosive sublimate and about 
seven and a half grains of iodide of potassium three times daily. 
April 26th. The same was ordered continued with the ex- 
ception of taking the medicine four times daily and increasing 
the dose of iodide of potassium to ten grains. 
May 1st. The patient called and his eyes are practically 
well. He is ready to go to work and feels well in every respect. 
The points of interest in this case are, in the first place, the 
fact that the patient contracted two chancres relatively so far 
apart. The fact that the inguinal ganglia attained such largo 
dimensions pointed to some inflammatory action going on ; and, 
yet, subsequent developments would seem to indicate that their 
size was due solely to the syphilitic process 
The time of primary incubation ( from Nov. 21st 1885 to Jan. 
6th, 1886) is one which is quite lengthy—forty-six days. It is 
considerably over the average and there can be little probability 
of the patient having made a mistake, as it was immediately 
prior to his departure for this country that he had connection. 
The period of secondary incubation, on the other hand, was 4 
quite short, being but twenty-five days. The eruption was the 
ordinary erythematous syphiioderm, which yielded rapidly and 
easily to ordinary treatment: and yet in thirty-five days, after 
a rest of about twelve days, we find gummata developed in the 
eyes,—formations involving the deeper tissues and justly rele- 
gated to the evidences of the tertiary form of syphilis. 
A curious fact in connection with this is that the patient has 
not had any other manifestation of syphilis. After the small 
papules disappeared there was no more evidence upon the cu- 
taneous surface, and he has since had neither mucous patches, 
condylomata, alopecia or other symptoms so commonly ob- 
served in the secondary stage. 
The, great efficiency of hypodermic treatment was shown in 
this case. The only inconvenience experienced was the burning 
sensation produced by the bicyanide, which lasted for a couple 
of hours after each injection. No abscess formed and no other 
inconvenience was noted. The injections were all made in the 
integument around the base of the scapula, the two sides being 
alternately taken. 
In conclusion, I think that I may safely say that this case is 
an example of a precocious syphilis (syphilis prtcoce), and that 
it will be well to keep the patient constantly under the influence 
of the mixed treatment to guard against the possibility of the 
occurrence of that disastrous form known as cerebral syphilis. 
The fact that gummata formed so early in the iris is evidence of 
the tendency which exists in this individual, and the brain is one 
of the organs of predilection for these deposits. 
I have not dwelt at greater length upon the ophthalmic feat- 
ures of the case, as Dr. Barck, who closely observed the patient 
in this respect, intends publishing a paper on these points and it 
will very properly supplement this short clinical report. In 
pursuing the treatment, the iodide of potassium will be gradually 
increased, until the limit of the patient’s toleration is reached, and 
then he will be kept upon what will be the proper dose for so 
long a time as the exigencies of the case will seem to demand, 
the mercurials being steadil}’ continued.