Journal of the American Medical Association
pustules on the skin as well as from the urethra contained extracellular, gram-negative diplococci ; pus cells were very numerous. The eruption was widely distributed, bilateral and tended to be symmetrical. The distribution was grouped, although there were scattered lesions on all parts of the body. There were groups, several confluent, on the buttocks, thighs, legs, feet, arms and forearms. The lesions in the beginning were vesicles or pustules on an erythematous base. After some of the older
... r some of the older lesions had dried up and were brushed off, there was left a smooth, pink surface underneath. The smallest lesions measured from 3 to 4 mm. (about % inch) in diame¬ ter; the larger ones were from 2 to 4 cm. (% inch to lVs inches). The base was raised and covered with a keratin scale. Some of the larger lesions presented almost a mussel shell appearance. About the inner surface of the ankles and on the soles there were numerous convex pustules with hard and thickened caps ; these grad¬ ually and slowly became enor¬ mously thickened and keratinized. The discrete lesions were convex and cornified, and were conical, enlarging gradually to the base. On the soles, espe¬ cially over the ball of the foot, they became confluent, and there was an enormous thick¬ ening of the epidermis. The appearance of these lesions was very striking, and resem¬ bled no other eruption. The course of the eruption was prolonged. After one month the lesions were crusted, cornified and yellowish ; at the end of two months most of the lesions on the trunk and arms were completely keratinized and brushed or scraped off, leaving pink, smooth skin un¬ derneath. Lesions on the soles led to an entire desquamation of the enormously thickened skin. At the end of three months the eruption had healed entirely, but it was six months before the arthritis had cleared up, and the patient had a prolonged recovery and convalescence. The diagnosis of the condi¬ tion was : gonorrheal urethritis ; balanitis ; arthritis; myo¬ carditis ; keratodermia blennorrhagica. 334 Lowry Building. Respiratory Symptoms Due to Latent Syphilis.-Syphilis may ape any disease. Prior to the discovery of the tubercle bacillus, pulmonary syphilis was believed to be common. Following Koch's discovery, the reporting of cases of syphilis of the respiratory tract became quite rare. The experience at the Henry Phipps Institute has been that symptoms and physical signs due to latent syphilis cannot be distinguished in the beginning from those due to pulmonary tuberculosis. Syphilis is to be suspected as the cause of the trouble: (1) if the sputum is persistently negative for tubercle bacilli; (2) if stigmas of syphilis are found (history of miscarriages, noc¬ turnal headaches, tenderness over the sternum, enlargement of inner end of clavicle, atrophy and induration of testicle, etc.) ; (3) if the Wassermann reaction is strongly positive; (4) if there is an amelioration of the symptom following antisyphilitic treatment.-Bull. Henry Phipps Institute.