Case Report Severe Gummatous Ulceration Of Face And Auricular Region.

IN these days of modern diagnosis and free treatment, gummatous ulceration of a severe type is relatively rarely encountered in persons under the age of forty-five years. It is seen, as a rule, in elderly people whose primary infection dates back for many years. The patient concerned here is a married woman, thirty-four years of age and under 8 stone in weight. She first attended at Salford Municipal Clinic on November i8th, I935. The history she gave was as follows: In September, I933, her husband suffered from a penile sore about which he refused to consult his doctor, but which he himself treated by means of some antiseptic ointment. Within a few weeks the lesion healed; but it was succeeded by a non-itchy generalised cutaneous eruption accompanied by sore throat. This, again, received no medical attention, and, in consequence, the diagnosis of syphilis was not then made. At the end of December, I933, the patient herself suffered from sore throat and a rash. These eventually disappeared under domestic treatment. In April, I934, a dusky eruption appeared on the left side of the face between the outer canthus of the eye and the ear. She consulted a practitioner, who had a blood-test done, the result of which was " strongly positive." She was made acquainted with the diagnosis, and the necessity for treatment was emphasised. Unfortunately attendance at a clinic was deprecated; and, more unfortunate still, private treatment was not begun owing to the patient's inability to find the not inconsiderable sum requested in advance. Between April, I934, and October, I935, the skin in the area referred to gradually became thickened. On October