AN UNUSUAL CASE OF SYPHILIS. 
BY 
J. ABBOTT CANTRELL, M.D., 
PROFESSOR OF DISEASES OF THE SKIN IN THE PHILADELPHIA POLYCLINIC 
AND COLLEGE FOR GRADUATES IN MEDICINE *t DERMATOLOGIST 
TO THE PHILADELPHIA AND ST. AGNES* HOSPITALS. 
FROM 
THE MEDICAL NEWS, 
October 6, 1394. [Reprinted from The Medical News, October 6, 1894.] 
AN UNUSUAL CASE OF SYPHILIS. 
By J. ABBOTT CANTRELL, M.D., 
PROFESSOR OF DISEASES OF THE SKIN IN THE PHILADELPHIA POLYCLINIC 
AND COLLEGE FOR GRADUATES IN MEDICINE ; DERMATOLOGIST 
TO THE PHILADELPHIA AND ST. AGNES* HOSPITALS. 
The following record of a case of syphilis is more 
than usually interesting, as the symptoms and course of 
the disease presented very decided irregular conditions 
during a period covering eighteen months, during a por- 
tion of which time the patient was under my care. I 
wish to emphasize the extreme malignancy of the dis- 
ease, the persistent cutaneous manifestations, the thera- 
peutic difficulties encountered, and the thorough care- 
lessness of the man in following directions as to treat- 
ment. 
W. W., a male, forty-three years old, has been under 
observation for a period covering twelve years. During 
that time he has been in the habit of taking periodic 
“sprees,” and while each of these would last only one, 
two, or three days, he nevertheless kept more or less 
under the influence of liquor for several months consecu- 
tively ; and although a married man and one of the best 
of husbands in the interim, he would often, during these 
sprees, have a lapse of sexual virtue, which in a number 
of instances resulted in attacks of gonorrhea. This con- 
dition generally responded to proper treatment and was 
cured in a few days. Unfortunately for him, the last of 
these sprees occurred about the 15th of November, 1892, 
while he was away from home, at which time there ap- 
peared the initial lesions of syphilis. He permitted 2 
himself to go untreated for about five weeks, at the end 
of which time he presented himself at my office. On 
December 24, 1892, the man stated that he had always 
been in the best of health, with the exception of the pre- 
ceding troubles. He was five feet seven inches in height, 
and weighed one-hundred-and-seventy-five pounds. 
Upon examination I found an initial lesion just be- 
hind the corona glandis and on the superior surface of the 
penis. I advised the use of the official mercurial oint- 
ment, and upon his return one week later the lesion 
was found to be entirely healed. As he was weak and 
not at work, I ordered one-sixteenth grain of mercuric 
chlorid, to be taken every six hours, for its tonic effect 
only; but it was found, after he had taken five doses, that 
he became salivated, and the drug was discontinued. 
After this (January 3, 1893) the patient was lost sight of 
until April 9th, when he again called, stating that he had 
had no treatment since last seeing me. 
At this visit I found that the man had been suffering 
from lesions upon the skin for the previous three weeks. 
Upon removing his clothing I noticed that these lesions 
were scattered here and there over the body-surface. 
Upon the face the lesions were situated directly above 
and between both eyes—“ corona veneris; ” another was 
found occupying a position directly above the left eye; 
another covered the right ala of the nose; there was one 
immediately below the angle of the jaw on the left side, and 
one was situated in the median line of the neck below the 
chin. Each shoulder was the site of a lesion ; the left arm 
upon the outer side contributed four similar lesions, 
and there were three upon the internal surface. There 
were also three surrounding the right wrist; nine 
lesions were encountered upon the chest and abdomen, 
while only five were seen upon the posterior portion of 
the trunk. I also found twenty-five lesions upon the left 
leg, the right contributing ten more. Upon close exami- 
nation I found that all were examples of the large, flat, 3 
pustular syphiloderm, and that each lesion (all lesions 
were circinate) ranged in diameter from one-fourth of 
an inch to two inches, and all were covered with a rupia- 
like crust, in some instances raised about one-half inch. 
There was apparently no discharge from any of them, 
but upon removing one of the crusts I found a decided 
exudation of pus. I advised mercury protiodid in doses 
of one-fourth grain to be taken three times a day, and 
after the man had taken three or four pills I was again 
confronted with the constitutional effects of the drug. 
I changed the remedy and gave potassium iodid in 
small doses, with the understanding that the dose was 
to be increased. 
On June ist the man complained of severe pain in the 
head, which, in fact, was only a sign of a cerebral 
neuralgia; but the pains resembled very much those 
found in connection with a gumma of the brain. These 
pains, peculiarly, were more noticeable at night, and 
only in the daytime when he was alone. Thinking to 
assist the potassium iodid, of which he was taking fif- 
teen grains three times a day, I advised inunctions of 
half-strength mercurial ointment. Salivation again or- 
curred after three or four applications, and, of course, 
these were discontinued, and after a week, all signs of the 
former characteristic effect of the drug having disap- 
peared, I again gave him the bichlorid, but in doses of 
of a grain three times a day; but the same effect 
was produced after a few doses. 
On June ioth, at my request, the man was admitted 
into the wards of St. Agnes’ Hospital, under my care. 
The pains in the head seemed to be very much worse, 
and in fact so much so that I was sure that a gumma 
was present. At this time he was given hypoder- 
mics of morphin before sleep was induced, and the 
potassium salt was increased to twenty grains three 
times a day. These means were continued for two 
weeks, when he was again removed to his home. On 4 
June 24th the pains had entirely left the head, but 
at this time he complained of general neuralgia (more 
properly a myalgia), the pains extending over the entire 
body, there being no one portion that was exempt. From 
this time he began to lose power in every muscle, and 
consequently was confined to bed, and simply remained 
n the position in which he was placed by the attendant. 
At times, while lying in one position, the pains would be- 
come severe in a portion of his body, and then he would 
be changed in bed, with relief for possibly a half-hour, 
when another change would be demanded. During all 
this time his appetite remained of the best. 
On July 6th entire disappearance of the myalgia was 
noted, but the man was still confined to his bed and un- 
able as yet to move any portion of his body—the head, 
the trunk, or the extremities. I noticed at this time that 
he was losing flesh (present weight 125 pounds) so rapidly 
that I thought that death would surely occur. His voice 
began to fail. He was taking thirty grains of potassium 
iodid three times a day. On July 10th he had lost his 
voice entirely, and on July 14th he had several chills, 
for which I advised large doses of quinin. 
On July 16th the chills were entirely relieved, and I 
gave cod-liver oil, 3'ij, three times a day. On July 23d 
the man used the right hand slightly and the voice had re- 
turned. He had no pain whatsoever. I noticed that the 
crusts which, up to that time, had remainded as described, 
had fallen off, leaving a spot having the color of raw ham. 
On July 27th he was able, with the assistance of the 
nurse, to sit up in bed for an hour. On August 3d the 
potassium iodid was increased to forty grains three times 
a day. The man was able to stand on his right foot, but 
had no power in the left leg whatever. On August 10th 
he was able to walk about five steps, with slight assist- 
ance, but there was still no power in the left leg. On 
August 20th, by supporting himself, and without other 
assistance, he could walk five or six feet, and on Septem- 5 
ber ist, with assistance, he could walk about twenty 
feet On September 25th, without other assistance than 
crutches, he was able to walk twenty-five feet. The 
iodid was now increased to fifty grains three times a day. 
On October 20th, with one crutch and one cane, the man 
could walk about thirty yards; although he still had 
very slight power in the left leg, he could stand upon the 
right foot without other support. The lesions showed a 
very dark pigmentation. On November ist he walked 
one hundred yards with the assistance of his crutch and 
cane. By December ist he walked one-half mile, hav- 
ing his crutch with him, and on January ist he walked 
three miles, still having his crutch with him, because he 
was afraid to go without it, as he was somewhat unsteady 
as yet on his feet. 
The man was again lost sight of until about the 9th of 
March, when I saw him on his doorstep, and he stated 
that he had been wearing some electric apparatus. He 
was unable to walk, or even to stand on his feet. Since 
that date I have not seen him. The Medical News. 
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