[Extracted from the American Journal of the Medical Sciences for January, 1878.] 
TATTOOING AS A MEANS OF COMMUNICATING SYPHILIS; 
AN INVESTIGATION OF 
TWENTY-TWO CASES EXPOSED TO INOCULATION WITH THE VIRUS OF 
MUCOUS PATCHES, IN FIFTEEN OF/WHICH SYPHILIS FOLLOWED. 
By F. F. MAURY, M.D., 
LECTURER ON VENEREAL DISEASES AT THE JEFFERSON MEDICAL COLLEGE, ATTENDING 
SURGEON TO THE PHILADELPHIA HOSPITAL ; 
AND 
C. W. DULLES, M.D., 
LATE INTERNE AT THE PHILADELPHIA HOSPITAL. 
In the beginning of September, 1877, a man presented himself Tn Dr. 
Maury’s wards in the Philadelphia Hospital, having upon his arm a sore 
which had the characteristics of a chancre, and suffering from other evi- 
dences of constitutional syphilis. The chancre was situated upon a tat- 
tooed figure, which had been placed there about two and a half months 
before, by a “professional” tattooer who moistened his pigments in whole 
or in part by inserting in his mouth the needles he used. So interesting 
a matter at once engaged earnest attention, and led to the investigation, 
first, of this one case, and afterwards of others in this city and in Reading, 
where such extensive tattooing had been done that the physicians in the 
town had had their attention attracted to its evil results, and were glad 
to co-operate with us in determining their nature and extent.1 
With regard to the latter point, however, we have not been able to ar- 
rive at any, even approximate, conclusion. The number infected must be 
much larger than that which we have been able to reach. For six months 
has this tattooer had lesions, which are hereafter described, and during all 
that time been doing his Avork whenever he had an opportunity, in Phila- 
delphia, Reading, Jersey City, and New York ; and the majority of those 
tattooed must have received the seeds of his disease. 
1 At this point we wish to acknowledge with thanks our obligation to Doctors Mar- 
shall, Kalbach, Kuhn, Reeser, Ammon, Luther, and Weidinan, of Reading, for facili- 
tating our investigations in the latter city; and to Doctors Kerr and Anderson, internes 
at the Philadelphia Hospital, for assistance in different ways. 2 
From the time our investigations began, the securing and examining 
the person of the tattooer was considered of the utmost importance, both 
in the interests of science and for the safety of the community. Conse- 
quently the police in different parts of the country were notified and search 
instituted for him. On the 13th of October he was arrested, with all his 
implements, in Philadelphia, and sent to the Philadelphia Hospital. lie 
was there fully identified by a number of his victims ; and later in the day 
was, at the suggestion of Dr. Maury, committed to the House of Correc- 
tion, where he is at present. . 
The following is his history, as given by himself and carefully compared 
with the records of the Philadelphia Hospital and the statements of those 
whom he tattooed. 
James Kelly, set. 20, born in Bucks Co., Penna., by trade a painter, 
but actually a vagrant; was examined October 13th, and again, through 
the courtesy of Drs. Hendrie and Pennybaker, at the House of Correction 
October 25th. 
A man of extremely bad habits, a very hard drinker, a constant chewer 
of tobacco, and of filthy personal appearance. He never had syphilis until 
early in February, 1877, when he contracted four or five chancres, followed 
by an inguinal bubo. Under self-treatment, he did so badly he was com- 
pelled, Feb. 17th, to betake himself to the Philadelphia Hospital, where 
he was treated locally by cauterization of the chancres with nitric acid, 
and the application of lotio nigra and iodoform. On March 6th he left the 
hospital and went to Reading, where he remained about a month, tattoo- 
ing as occasion offered, then for a short time to Jersey City, and returned, 
April 14th, to the hospital to be treated for mucous patches in his mouth 
and condylomata about his anus. He remained here until May 16th, 
when he left uncured, and going to Reading continued his tattooing. 
From this time onward he seems to have communicated his disease to 
most of the subjects of his art.1 Remaining in Reading nearly a month, 
he then went for a few days to Jersey City, and on June 20th turned up 
for the third time in the Philadelphia Hospital, with mucous patches and 
condylomata still flourishing. On August 2d he was discharged for insub- 
ordination, and went to Jersey City. About this time he had iritis. He 
remained in Jersey City until October 6th, when he returned to Phila- 
delphia, where he was one week later arrested and committed to the House 
of Correction. 
At the time of our examination he has slight inguinal adenitis, mucous 
patches in his mouth, and a condylomatous patch at the bottom of his 
scrotum. The mucous patches in his mouth are extensive. Two are 
situated back of the angles and just within the lips. These are the only 
present manifestation of syphilis. 
The following was his customary method of tattooing : A figure having 
been selected from a book of plates which he carried with him, he would 
rub up India ink with water and pick the outlines in with a few needles 
set in a holder. Then putting the needles in his mouth and sucking out 
the residue of pigment, he would thrust them thus moistened into a bottle 
of powdered vermilion and insert what adhered. To renew the vermilion 
1 It will be noticed that all the cases here reported were tattooed at or after this 
time, viz : while he had mucous patches in his mouth. the needles were repeatedly wetted in his mouth. In some cases both 
pigments were moistened with saliva, and in others he spit upon the 
finished tattoo and rubbed it well with his hand or a dirty cloth he had. 
The figures he made were often very handsome, and always skilfully 
done. Indeed, this was his only means of livelihood, bringing him in 
fees ranging from a drink of whiskey to two dollars, according to the ex- 
tent and elaborateness of his work. 
Such, then, being the history of the tattooer and his method of operat- 
ing, wre will proceed to the consideration of its results as exhibited in the 
following twenty-two cases, which are not all that wre have examined, hut 
such as w e think of sufficient scientific interest, as wTell as of sufficient ae- 
curary to report. 
It may not be amiss to state here that, to attain as much thoroughness 
as possible, a definite plan of examination wras first prepared and each in- 
vestigation conducted according to it; that every patient was examined 
by us personally and scrutinized from head to foot; that the asking of 
leading questions wras avoided, especially in regard to the primary lesions, 
and that special inquiry was made to exclude the possibility of the syphilis, 
where it occurred, having been acquired in some other way than by the 
tattooing. Some apparent omissions in the accounts are attributable to 
the difficulties encountered from ignorance, forgetfulness, or unwillingness 
on the part of the patients. 
We have arranged the histories in the following classes :— 
I. Where the patients have never had syphilis, and yet were not inocu- 
lated so far as is now known. 
II. Where the patients had syphilis before being tattooed. 
HI. Where syphilis had never existed, but was communicated by the 
tattooing. 
Class I. Where the patients have never had syphilis, and yet were 
not inoculated, so far as is notv known. 
Case I—John M.,ret. 21, American, nurse, examined first September 
25, and repeatedly afterwards, in the Philadelphia Hospital. lie gives 
an unexceptionable family history. Fifteen years ago he had variola, of 
which the scars are very plain. lie had gonorrhoea four years ago, and 
this year a stricture, which was successfully treated in the Philadelphia, 
Hospital, while at the same time he was circumcised for congenital phi- 
mosis. lie was tattooed by Kelly once in May and once in June. Two 
figures wrere placed on each arm, the pigments, India ink and vermilion,, 
were mixed with Kelly’s saliva. Yet since that time, save a day’s inflam- 
mation of the arms, he has not had any ill effect. Careful and repeated 
inquiry and examination fail to discover any trace of past or present 
syphilis. 
Case II John E., aet. 23, Am., iron moulder, examined in Reading, 
October 1. He gives a good family and individual history. lie was 
tattooed by Kelly in June. The pigments used were India ink and ver- 
milion. The former was mixed with water, but Kelly put the needles in 
his mouth to suck off the India ink before putting in the vermilion. 4 
After the operation was completed, the patient washed his arm carefully 
with spring water. Since that time he has had no syphilitic manifesta- 
tions that he knows of, nor does our examination discover any. 
Case III—Samuel F., a young man working in an iron foundry, ex- 
amined in Reading October 1, gives a good family and personal history. 
He was tattooed by Kelly in June. The manner was similar to that in 
the other cases, in which though water was partly used to mix the pig- 
ments, the needles w’ere often put by Kelly into liis mouth. Since that 
time there has been no syphilitic manifestation whatever, so far as his 
history or our examination can discover. 
Case IV Joseph C.,set. 37, Am., labourer, examined in the Philadel- 
phia Hospital October 10. Five years ago had a chancre appearing about 
two weeks after exposure, and followed by a suppurating bubo in each 
groin. These burst. Aftenvards he had, so far as his memory serves 
him, no cutaneous eruption, nor any evidence of syphilis, except a year 
later, an ulcer on his right temple and one on his leg. At the same time 
he thinks he had swelling of the glands in the left axilla. He has never 
had alopecia, nor iritis, nor any syphilitic development on a mucous mem- 
brane. About the end of June he was tattooed by Kelly. Two small figures 
were placed on the dorsum of his left forearm, and upon his chest a large 
crucifixion. The pigments, India ink and vermilion, were mixed with 
water, but Kelly put the needles in his mouth after inserting the India ink 
so as to suck off what was left on them before putting in the vermilion. 
The tattooing w'as followed by a very insignificant local inflammation, 
and not a single evidence of syphilitic inoculation. At the time of our 
examination, three and a half months after being tattooed, the man is in 
perfect general condition. He has no adenitis, no alopecia, no eruption 
whatever. We think there is no evidence that he has had syphilis at any 
time. 
This last case presents some difficulty in classification, but we place it 
in this list because it appears to us that the lesion described as occurring 
five years ago was not a true chancre. The account of the period of in- 
cubation cannot be relied on after so great a lapse of time. The lesion 
was followed by two suppurating buboes, which opened spontaneously, and 
by no distinctive syphilitic manifestations whatever. The ulcers, appearing 
a year later, we do not think can be fairly connected with the sore on his 
penis* 
If in this we are not mistaken, we have then four cases where, for 
some reason, the subjects of the tattooing have entirely escaped syphilitic 
inoculation. It is possible that even yet it may manifest itself, but up to 
this time the immunity has been perfect. 
Class II. Where the patients had syphilis before being tattooed. 
Case V William W., net. 23, Am., laborer, was examined in the 
Philadelphia Hospital Sept. 22, and repeatedly afterwards. He gives a 
good family history ; has been himself a steady but moderate drinker. In 
October, 187G, he had gonorrhoea, and in February, 1877, a phagedenic 
chancre, which destroyed his whole glans penis. This was followed by a 
papular eruption on his legs and mucous patches in his mouth, one of 
which was very large. While in the Philadelphia Hospital, and when these 5 
secondary manifestations were at their height, he was tattooed by Kelly. 
A figure of a bracelet was placed round each wrist. The pigments, India 
ink, coal dust and vermilion, were mixed with Kelly’s saliva. There fol- 
lowed only a very trilling local inflammation, and no other effect that he 
knows of. At the time of our examination he has papules and squamae 
in his scalp, an unhealed ulcer of the stump of his penis, and a serpiginous 
ulcer of the fibular side of his left leg. 
Case VI—Thomas L., aet. 27, Irish, labourer; a man stubborn, igno- 
rant, and mendacious, was examined, by courtesy of Drs. Morton and 
Kirkbride, at the Pennsylvania Hospital September 25, and once later. 
He gives a good family history. He denies any previous venereal dis- 
ease, until our physical examination detects a fine parchment-like indura- 
tion on his glans penis, when he admits he has had a chancre there in 
May, but still denies any cutaneous manifestation. 
About the end of June he was tattooed by Kelly. The figure of a cru- 
cifix was placed on the ventral aspect of his right forearm. The pigment 
used was coal dust, which was spit upon by Kelly and picked in with 
needles. There followed moderate swelling of the arm, but no axillary 
bubo. In about a month there appeared, on a spot of the figure repre- 
senting the left nipple, a papule, which did not itch. This he scratched 
with a pin, and it became a pustule, which spread until it formed an indurated 
and elevated ulcer, having a diameter of about three-quarters of an inch. 
This was poulticed, and an “ Indian salve” applied; some time afterward 
he entered the Pennsylvania Hospital, where he was treated locally Avith 
lotio nigra and constitutionally with red iodide of mercury and iodide of 
potassium. 
At the time of our examination he has on his body a few old maculae. 
There are papules in his scalp, on his forehead, body—particularly where 
his waistband has pressed—legs, and soles. lie has a few crusted pustules 
on his body. In his mouth is a mucous patch. The ulcer on his arm is 
healing nicely. On his glans penis is the indurated scar of his old chancre, 
lie 1 las enlargement of his post-cervical and right supra-trochlear glands, as 
well as those in both groins and over both saphenous openings. 
This case we cannot place in any other class than this because of the 
peculiar scar upon his penis, which seems to be that of a chancre antedat- 
ing his tattooing, and which we take to be the starting point of his syphilis. 
Case VII—David M., ad. 20, Am., coach painter, A\ras examined in 
the Philadelphia Hospital Sept. 22, and repeatedly afterward. lie gives 
a good family and personal history. Previous to this year he never had any 
venereal complaint, though for ten years he has led an irregular life. About 
the end of last April he contracted three sores upon his penis, which were 
treated with iodoform, and healed in six days. 
On the sixth of May, while in the Philadelphia Hospital, and, he thinks, 
well, he \Aras tattooed by Kelly. The operation consisted simply in putting 
in three radii of an incomplete eight-rayed star, two and a half inches in 
diameter, situated in the skin over the head of the right humerus. The 
pigment used was India ink, which was mixed with Kelly’s saliva. Fol- 
lowing this, there was considerable swelling of his arm, which passed off 
in a few days without treatment. In about two weeks, however, there 
were developed three papules, one on each of the newly made radii, which 
did not itch, but passed on to pustulation, broke, extended, and coalesced. 
To this sore he applied a salve of beeswax and lard. A bubo soon formed in his axilla, which subsequently subsided without suppurating. lie next 
noticed that, after a short period of fever, a series of papules appeared be- 
tween his scapulas. This he thinks was within a week of the appearance 
of the sores on his shoulder. The papules passed on to pustulation, and 
then he observed the development of squamae and papulae in his scalp. 
Then came enlargement of the post-cervical lymphatic glands, and three 
papulae on his penis, with some on his scrotum. 
At the time of our examination he has upon his right shoulder, cover- 
ing the lower half of the star mentioned, a portion of skin of irregular 
outline, about two inches in diameter, elevated one-eighth of an inch above 
the general surface, indurated, of a coppery-red colour, and having near its 
centre an ulceration still more elevated and about half an inch in diameter. 
In his scalp are maculae, squamae, and papulae, the same on his forehead, 
with a few papula; and pustuhe distributed over his body. Upon his penis 
are a number of papules within and without his prepuce, which is long 
and indurated. lie has sore throat, a fissure of the right angle of the 
mouth, post-cervical adenitis and osteocopic pains. 
This case may, perhaps, be one where the tattooing was the origin of 
syphilis, but the appearance of the lesion on the shoulder and the almost 
immediate appearance of the papular eruption between the scapula; make 
us hesitate to come to such a conclusion. For this reason, we prefer to 
place it in this class, as though the sore which existed on his penis when 
he was tattooed had been indeed a chancre. 
Class III. Where syphilis had never existed, hut teas communicated 
hy the tattooing. 
Case Till—George F. B., act. 17, Am., ice carrier; examined in 
Reading, October 1, gives a good family history, and has had a healthy 
life, excepting a fever when five years old, and gonorrhoea and gonorrhoeal 
rheumatism four months ago; both of which were cured before he was 
tattooed. Ilis habits have been free and easy. 
About the middle of June, being quite well, he was tattooed on the 
right forearm by Kelly. The figure chosen was a shield, with three dark 
and two light bars. The pigments were India ink and vermilion. The 
needles were constantly in Kelly’s mouth. A slight local inflammation 
followed, with reddening of the lymphatics up to his elbow, and glandular 
involvement. By an application of glycerine and cold water the arm 
healed, leaving, however, two weeks later five small elevations like mosquito 
bites, upon which were crusts. These papules itched, were scratched, and 
passed into pustules. They were treated some time later with a salve of 
red oxide of mercury and dry application of calomel, under which they 
healed. Five weeks after these sores the supra-troclilear gland became 
enlarged. About three weeks later, ten after the tattooing, he noticed 
squamae in his scalp, then a mucous patch came in his mouth, and a 
condylomatous patch between his buttocks. lie has for five weeks been 
under good specific treatment. 
At the time of our examination he has a very few crusted papules in 
his scalp; a few scattered macula; over his chest and abdomen ; slight 
post-cervical and inguinal adenitis ; some inflammation of the fauces, and, 
on the left of his anus, a small slightly elevated condylomatous patch, 
about a third of an inch in diameter. 7 
Case IX John N., fet. 18, Am., brushmaker; examined in Reading, 
October 1 ; gives a good family and personal history; has led a free and 
easy, but not a hard, life. 
About the end of May, being quite well, he was tattooed by Kelly on 
the flexor aspect of his right forearm. The figure was a dancing girl on 
an eagle, holding a flag in her hand; the pigments, India ink and vermilion, 
mixed with Kelly’s saliva. There followed slight local inflammation, 
accompanied by a red streak up the arm. After an interval of five weeks 
there appeared at the lower inner corner of the flag a papule, elevated, 
indurated, with an areola and itching. It was scratched and formed a 
pustule, which persisted two months. Meanwhile it was once cauterized 
with an acid, and simple soap applied. Four weeks later, nine after the 
tattooing, there appeared a papular sypliiloderm, most marked on his 
scalp and scrotum. 
At the time of our examination we find his thighs a little marbled, 
papules on his hands and feet, on his right buttock two medium sized 
condylomata. The glands in his right groin are enlarged, and he has a 
beautiful post-auricular adenitis. 
Case X Cyrus S., ajt. 26, Am., boatman ; examined in Reading 
October 2 ; gives a perfectly good family and personal history; is an 
occasional but not a hard drinker, and stands now a large magnificently 
developed man, weighing lbs. 
In .Tune, being quite well, he was tattooed by Kelly on the back of the 
right hand. The figure was a ten rayed star; the pigments India ink and 
vermilion, mixed with Kelly’s saliva. There followed a great deal of local 
inflammation and an axillary bubo. lie did nothing for this condition, 
and in about a week, during its continuance, there appeared in the red 
colour a lump which, he says, was “ like a pill” under his skin. This was 
painful, had an areola, itched, and was, as stated, indurated. It was 
scratched, became covered with a crust, by repeated removal of which it 
grew larger. In two weeks more, after a period of marked malaise and 
fever, there appeared a papular eruption in his scalp, on his forehead and 
face, in his nose, between liis nates, on his penis, scrotum, palms and soles. 
Retween his nates the papules developed into condylomata with “ terrible” 
itching. In his mouth mucous patches also appeared. There were some 
pustules among the papules on his hands, feet, and penis. lie has been 
of late under good treatment. 
At the time of our examination, we find in his scalp %and on his fore- 
head and face traces of maculae and papules. His chest, abdomen, back, 
thighs, and legs are beautifully clean. Between his nates are traces of the 
former condylomata and a few papules. On the soles of his feet are scars 
of many old papules. His fauces are erythematous. On his upper lip, 
left side, is a small mucous patch. lie has slight enlargement of the 
submaxillary lymphatic glands, post-cervical adenitis most noticeable on 
the right side, and marked alopecia. 
Case XI Jacob II., set. 18, Am., examined in the Philadelphia Hos- 
pital October 15, is a young man of good appearance, with a good family 
and personal history. He says he has never had sexual intercourse. 
About the beginning of June, being in perfect health, he was tattooed 
in Reading by Kelly. The figure of an eagle with a scroll in its beak, 
surmounted by a crown and two letters, was placed on the flexor aspect of 
his right forearm. The pigments, India ink and vermilion, were mixed with 
Kelly’s saliva alone. There followed scarcely any local inflammation. In 8 
about seven weeks there appeared on the right wing of the eagle two 
papules, which he compares to mosquito bites, developing into pustules, 
and soon followed by one on the crown and two on the scroll. There 
came in a short time a red streak extending up toward the axilla, and an 
axillary bubo. The pustules he burnt with nitrate of silver, and got some 
medicine from a doctor. Five weeks after the appearance of the papules 
there appeared a papule on his penis, then two on his scrotum, a few about 
his anus, a few on his head, and three on his left hand, with soreness of his 
gums and throat. About six weeks ago, when in the condition just de- 
scribed, he was treated locally and constitutionally with good results. 
At the time of our examination he has two or three nearly cured papules 
in his scalp, and as many in his left palm. His fauces are deeply inflamed 
and swollen ; his gums inflamed and ulcerated ; he has alopecia and en- 
largement of the inguinal glands on both sides. 
Case XII Edward W., set. 20, Am., wool-washer; examined, by 
courtesy of Prof. Wm. II. Pancoast, in the Philadelphia Hospital Sept. 
21, and repeatedly afterwards; gives an unexceptionable family history, 
and has always been healthy until last spring, when he had an attack of 
typhoid fever, which was treated in this hospital. He has been of steady, 
temperate habits, and never had any venereal disease. 
About the end of June he was tattooed by Kelly, upon the flexor aspect 
of the left forearm. The figure was a goddess of liberty seated upon an 
eagle, and bearing an American flag; the pigments were India ink and ver- 
milion, mixed with pure water. The operation was followed by a mode- 
rate and transient degree of local inflammation without any involvement 
of the lymphatics. Two weeks before this he had been tattooed by the 
same man on the flexor aspect of the right arm with the figure of a cruci- 
fixion. On the radial side of the figure and in the background were two 
oriental looking buildings, and on the ulnar side a small tree. The pig- 
ments, coal-dust and vermilion, were mixed with Kelly's saliva. The 
arm soon became extremely inflamed and swollen. This inflammation, 
however, subsided in four or five days, and he observed no involvement of 
the lymphatic vessels or glands. 
In about a month there appeared on the ulnar side of the base of the 
figure, a papule, which he compares to a mosquito bite. It itched much, 
was scratched, became purulent, and enlarged until there was a circum- 
scribed ulceration three-quarters of an inch in diameter, with a flat, some- 
what elevated, indurated base, and a well-defined areola. This process 
the patient watched carefully and describes accurately. At the time of 
the development of the papule the glands of the right axilla became en- 
larged. Six weeks later, about ten after the tattooing, a macular syphilo- 
derm developed upon his forehead, chest, belly, and legs, in this order, 
followed by a mixed squamous and papular syphiloderm. 
At the time of our examination the patient appears in excellent general 
condition. He is a stout, well developed, healthy looking young man. 
The ulcer described still persists on his right arm. On his forehead is a 
light, brownish syphiloderm. There are papules in his scalp, a few on 
his arms and back, very many on his palms and soles, and about his anus 
many passing into condylomata. His scrotum is so thickly covered with 
flat papules that it is hard to discover any interspaces. There are very 
many on his penis. "Within the prepuce these are excoriated and closely 
simulate chancres in a similar stage. On his thighs are some pustules as 
well as papules. He has also distinct right-sided post-cervical adenitis. 9 
Case XIII Joseph P., ait. 20, Am., iron moulder; examined in 
Reading October 1. Ills family history is perfectly good. About a year 
ago he had inflammatory rheumatism, lasting ten weeks. lie lias never 
had any venereal disease. Ilis habits have been regular and steady. 
In June, being perfectly well, he was tattooed on the flexor aspect of the 
right forearm, by Kelly. The figure was a 2, upon which lies a ladder. 
The pigments were India ink mixed with water, and vermilion mixed 
with Kelly’s saliva. There followed slight local but no glandular inflam- 
mation. This received no treatment. In about three weeks appeared a 
papule, elevated, indurated, and itching. This was scratched and developed 
into a pustule, which enlarged to about a half inch in diameter. It was 
treated with lead-water and laudanum, then later with lotio nigra and 
calomel, while he took some internal medicine. 
Ten days after the appearance of the papule, without preceding fever, 
the lymphatics of his arm became red and his axilla tender. Then appeared 
a macular and squamous syphiloderm, followed by papules around the 
corona glandis penis, and along the raphe, with a mucous patch in his 
mouth, swelling of the papillae of the tongue, and sore-throat. 
At the time of our examination the patient complains of indisposition, 
with pains in his back and stomach. Old maculae are distributed over his 
scalp and legs ; on his back, penis, and scrotum are a few papules, and 
many in his palms and soles. On the inside of the right check is a small 
mucous patch. Ilis submaxillary, postcervical, and inguinal glands are 
enlarged, and he has some alopecia and sore-throat. 
Case XIV—Charles P., aet. 19, Am., japanner; was examined in 
Reading October 1. Ilis family history is good. Four years ago he had 
typhoid fever; three months ago—since being tattooed—he had gonorrhoea, 
lie says his habits have been regular, and he is not addicted to excessive 
venery. 
About the middle of June, when in perfect health, he was tattooed on the 
flexor aspect of the right forearm, by Kelly. The figure is very large and 
thickly coloured. It represents a naked woman kneeling on a pedestal, 
under a dense weeping willow tree. The pigments, India ink and ver- 
milion, were mixed with Kelly’s saliva. For a week the arm was very 
sore, and a gland in the axilla swelled, but soon subsided. To the arm 
cold water was applied. In about two weeks appeared on the figure a 
single papule, which had a distinct areola, was indurated, elevated, and 
itched; yet was not scratched. It developed into a pustule, ruptured, 
became encrusted, and healed in two weeks without treatment. About 
two weeks later appeared, below the figure, a flat papule, accompanied by 
an axillary bubo. At the same time came a general macular syphiloderm, 
which desquamated and was succeeded by papules, which were profuse on 
his penis—he thinks there were seventy-five ! lie also had condylomata 
between his toes. At the time of our examination—three and a half months 
after his tattooing—he has maculaa and squamae on his scalp, and a well- 
marked corona veneris. There are papules on his chest, back, arms, legs 
(arranged in circles in the popliteal spaces), penis, scrotum, and soles. In 
his nose are crusted papules, on the right side of his uvula is an ulcer. The 
corresponding submaxillary gland is enlarged. lie has also bilateral in- 
guinal adenitis and well-marked alopecia and sore-throat. 
Case XV—Thos. G., act. 23, Irish, iron puddler; examined in the 
Philadelphia Hospital September 21, gives an unexceptionable family his- 
tory ; has had no serious illness before, nor any venereal complaint; has 
been a steady, but not a hard drinker. 10 
About the middle of June—at a time when lie was under treatment in 
the Philadelphia Hospital for traumatic orchitis, but otherwise well—he 
was tattooed by Kelly on the flexor aspect of the left forearm. The figure 
was that of a cross upon which was a wreath and a heart. The pigments, 
coal-dust and vermilion, were mixed with fresh water. Following the 
operation there was some soreness of the arm, lasting two days, and 
enlargement of the axillary lymphatic glands. Both these subsided readily. 
Three days previous to this tattooing Kelly had put on the flexor aspect 
of his right forearm the figure of a crucifix, with a background of two 
oriental looking buildings on the radial side, and on the ulnar a small tree. 
This time the same pigments were moistened with Kelli/s saliva. The arm 
became much inflamed, and the next day a gland above the internal 
condyle of the humerus and one in the axilla were enlarged ; of these the 
former subsided soon. The local soreness lasted three days, but required 
no treatment. About five weeks later, at a point upon the trunk of the 
tree alluded to, appeared two papules—which he compares to mosquito- 
bites. These developed into pustules, with indurated bases, burst and 
coalesced, leaving an elevated suppurating surface, about three-fourths of 
an inch in diameter, with a distinct areola, which he treated, himself, with 
cosmoline and iodoform. About this time the bubo in the axilla suppurated 
and discharged spontaneously. About ten weeks after the tattooing, and 
five or six after the appearance of the sore just described, he had a short 
period of feverishness and indisposition, and then appeared a papular 
syphiloderm, accompanied or followed by a fissure of the right angle of 
the mouth. 
At the time of our examination he has papules on his scalp, back, arms, 
penis, scrotum, nates, legs, palms, and soles, as well as between his toes. 
The number on his palms is very remarkable. On the cutaneous surface 
of his prepuce are papules, closely resembling hard chancres, while on the 
mucous surface are ulcerations simulating chancroids. The fissure of the 
right angle of the mouth persists. lie is suffering from a balanitis and 
gonorrhoea contracted recently. He has post-cervical adenitis, and is in a 
very much poorer general physical condition than he ever was before the 
tattooing was done. 
Case XVI Frederick R., fet. 21, Am., brickmaker; examined in the 
Philadelphia Hospital September 25; gives a good family history; has 
been of tolerably steady habits ; many years ago had an inguinal bubo, 
from over-walking; four years ago had gonorrhoea, from which he inocu- 
lated his left'eye with gonorrhoeal ophthalmia, resulting in its almost total 
destruction. About the end of May he was tattooed by Kelly. On the 
dorsal aspect of the left forearm was placed a dancing girl, and near it a 
cross, heart, and anchor. On the inner side of the upper arm was placed a 
goddess of liberty on an eagle. The pigments, India ink and vermilion, were 
mixed with Kelly’s saliva. The day following his arm was much inflamed, 
and a bubo formed in the axilla. Both the inflammation and the bubo 
passed away in a few days. A gland helow the inner condyle of the 
humerus now became enlarged and painful, and then subsided. Four 
weeks from the date of tattooing there appeared two swellings, one above 
the right knee and one on the left foot of the figure of the dancing girl. 
These he compares to a boil, with pus at the apex. They itched, were 
scratched, and crusts formed upon them. Later, appeared a fissure of the 
left angle of his mouth, and papules on his tongue, penis, and scrotum, 
and about his anus, as well as one or two on his left palm and one on his 11 
right foot. At our examination we find on his body traces of a macular 
syphiloderm; about his anus are three patches of ulcerating hypertrophic 
papules ; two similar patches on the left and one on the right side of his 
scrotum; traces of two healed patches also on his scrotum; one such patch 
in each thigh; and one on the right calf; his pharynx and fauces are in- 
flamed ; his tongue swollen and fissured ; a mucous patch inside the left 
angle of his mouth and one inside the lower lip. His eyes are inflamed, 
and seem to threaten iritis. lie has post-cervical adenitis. 
Case XVII—Daniel II., set. 21, Am., labourer; examined in the 
Philadelphia Hospital September 26 ; gives a family history of phthisis, 
himself has always been healthy and of steady habits, though an occasional 
drinker ; has never had any venereal disease. A year ago he was tattooed 
on the right forearm. Xo evil results followed. 
In the latter part of May of this year he was tattooed by Kelly on the 
dorsal aspect of the right forearm. The figure was a goddess of liberty 
upon an eagle; the pigments, India ink and vermilion,mixed with Kelly’s 
saliva. He was at the same time tattooed in the same way, on the left arm, 
with the figure of a little girl holding a bouquet in her left hand. Both 
these figures were followed by great local pain and swelling, and involve- 
ment of the axillary glands. The latter, however, subsided in a few days. 
In about three weeks there appeared on the figure on his right arm, and 
later on the other, a number of papules, which multiplied until on the former 
there were seventeen and on the latter twenty-four. In the latter case the 
papules appeared wherever the vermilion had been used. The first appear- 
ance of these papules the patient compares to mosquito bites. They were 
indurated and elevated, and had an areola; they itched, were scratched, 
became purulent, and formed crusts. A number of them were cauterized 
by a physician, an ointment applied, and they healed up in about a fortnight. 
The rest healed spontaneously. No axillary bubo followed. About the 
middle of July, about six weeks after the tattooing and three after the first 
syphilitic manifestation, a papular eruption appeared on his seal}), penis, 
scrotum, palms, and soles, and in his nasal cavity and external auditory 
canals. Later, on his forehead and lips was developed syphilitic impetigo. 
In three months from the time of tattooing mucous patches appeared in 
his mouth. Since the early cauterization he has been treated with “roots” 
by a snake doctor. At our examination we find many desquamating papules 
in his scalp, a few large papules on his abdomen, three smaller ones around 
his corona glandis penis, one on the frenum, four on the scrotum, nine on 
his thighs, one in the left popliteal space, and the traces of very many on 
his palms and soles. On his forehead are four beautiful crescentic patches 
of impetiginous pustules, and on his lips several more. Ilis lips and mouth 
are covered with mucous patches, and about his anus he has immense 
condylomata. 
Case XVIII—John G., ret. 16, Am., machinist; examined in the 
Philadelphia Hospital September 29 ; his family and personal history is 
excellent. About the end of May, when in perfect health, he was tattooed 
in Reading by Kelly, on the flexor aspect of his right forearm. The figure 
was that of a dancing girl; the pigments, India ink, mixed with water, 
and vermilion, mixed with Kelly’s saliva. After pricking in the colors, 
Kelly spit on the patient’s arm and rubbed it well. Slight and transient 
local inflammation followed, for which cold water was applied, but there 
was no glandular swelling. In four weeks there appeared on the left 
shoulder of the figure a papule, indurated, itching, and having an areola, 12 
followed, the next week, by six similar ones, scattered over the figure. 
They all developed into pustules under the influence of scratching. He 
now received treatment, which he describes as a salve and powders. Two 
weeks later, six after the tattooing, without preceding fever, a number 
of small lymphatic glands below the elbow-joint enlarged, and a lymphatic 
vessel, running from them to the axilla, became hard, like a whip-cord. 
These conditions persist sit this time. He next noticed a papular eruption 
on the soles of his feet, with a few papules on his back and neck, the latter 
developing into pustules. lie now treated himself with gin and mandrake 
roots. At the time of our examination, a little more than four months after 
his tattooing, we find his scalp clean, patches of copper-coloured spots 
on his forehead, papules in his nasal cavity and right external auditory 
meatus, on his face, a few on his chest, several hypertrophic and encrusted 
on his abdomen, one in his right axilla, quite a number of medium size on 
his hack and buttocks, many on his arms, penis, scrotum, thighs, shins, 
and both soles. There are a few pustules on his back. Between his nates 
are three condylomatous patches, and others between the toes of both feet, 
lie has slight erythema of the fauces and a large mucous patch on the roof 
of his mouth. lie has not very well-marked post-cervical adenitis. 
Case XIX Alvin S., mt. 20, Am., teamster; examined in the Phila- 
delphia Hospital September 29; gives a perfectly good family and personal 
history, except that he had, in 1875, a gonorrhoea lasting seven months, 
and in 1876 another attack which was cured in two weeks; his habits 
have been pretty steady, though occasionally indulging in venery. 
About the end of May, 1877, being perfectly well, he was tattooed by 
Kelly on the flexor aspect of his left forearm ; the figure was that of a 
dancing girl ; the pigments India ink mixed with water, and vermilion 
mixed with Kelly’s saliva. There followed a slight local inflammation 
lasting but two (lays, and presenting no involvement of the lymphatics, 
which he did not think demanded any treatment. Two weeks from the 
tattooing there appeared on the breast of the figure three papules, then 
two more on the left lower part of her scanty dress, and a week later on 
the crossed ankles another. These were hard, elevated, and red; spread 
into flat papules, desquamating somewhat, and finally secreted a little 
pus. Soon after their appearance they were cauterized, and the patient 
constitutionally treated by a regular practitioner. In about two weeks, 
without any preceding fever, there appeared upon his legs below the 
knees, a squamous syphiloderm, followed by many papules and pustules 
on his thighs, scrotum, and penis. Of the latter some were excoriated. 
About the same time he noticed an enlargement of the left supra-trochlear 
gland. For this stage of the disease also, he was treated constitutionally. 
At the time of our examination he had a gonorrhoea two weeks old ; in 
his scalp are many maculae, and a few on his chest and shins; there are a 
few papules on the side of his nose, and some encrusted ones in its cavity, 
many on his thighs, and a number on both soles. There are a few pus- 
tules on his back—perhaps acne. Between his nates are two condyloma- 
tous patches, and others between the third and fourth, and fourth and fifth 
toes of the right foot. lie has erythema of the fauces, an ulcer on the 
right side of the uvula, mucous patches on the edge and lower surface of 
his tongue, very large ones inside the angles of his mouth, and smaller 
ones within both lips. One seems to be developing on the roof of his 
mouth. He has marked submaxillary adenitis, alopecia, and left iritis. 
Case XX J ames F. P., ait. 25, American, iron moulder; examined 
in Reading October 1; gives a good family and personal history, except 13 
that two years ago he had an attack of gonorrhoea which lasted four 
months. His habits have been pretty good, and lie never drinks. Years 
ago he had a suppurating bubo in the left groin from an ingrowing nail, 
lie was tattooed by Kelly about the middle of June, being then perfectly 
well. A female bust was placed upon the flexor aspect of his right fore- 
arm, and above it two crossed branches. The pigments, India ink and 
vermilion, were mixed with water and Kelly’s saliva, the needles being 
frequently put in his mouth. There was slight and transient local inflam- 
mation, and no glandular involvement. lie applied cold water to his 
arm. In four weeks there appeared upon the tattooed figure, many small 
papules, which were not sore nor purulent, nor have they ever been 
abraded or excoriated, though now having a tendency to scale a little. 
They received no treatment. In about six weeks from the date of tattoo- 
ing, there appeared on his forehead and penis a papular eruption, then 
later mucous patches on the tip of his tongue and the sides of his gums. 
For these he had no treatment. 
At the time of our examination we find a few papules on his body, and 
between his nates, two on his corona glandis penis, crescentic patches in 
his popliteal spaces, a few on his knees, shins, and ankles, his palms and 
soles crowded with them. In his mouth are a number of mucous patches, 
lie has post-cervical, submaxillary and inguinal adenitis, with marked 
enlargement of his right supra-trochlear gland, and one behind his left 
ear. He has also alopecia and osteocopic pains. 
Case XXI George II., act. 23, American, laborer ; examined in Read- 
ing October 2 ; gives a good family and personal history; has been of some- 
what irregular habits, but not a hard drinker. About the end of May, being 
quite well, he was tattooed by Kelly on the left forearm. The figure was 
a goddess of liberty with a flag, and two crossed branches below; the pig- 
ments were India ink mixed with water, and vermilion mixed with Kelly’s 
saliva. Kelly also spit on the arm and rubbed the colours in. There was 
considerable local inflammation, but it was treated simply with soap and 
water. In about two weeks there appeared a papule in the middle of the 
crossed branches, and in two days three more near by. They developed 
into pustules and formed deep ulcers which were treated and healed in 
three weeks. The scars persist, and are about half an inch in diameter. A 
month after these papides he had a period of fever with marked malaise, 
followed by a general erythematous eruption, then maculae and squamae 
on his chest and shins, followed by papules on his head and forehead, in 
his nose, on his arms, legs, palms, and soles, and between his toes. Later 
he had mucous patches in his mouth and condylomata about his anus. 
At the time of our examination we find a few maculae on his chest. 
There are traces of very many small papules on his forehead. Papules in 
various stages of development or recession are distributed over his back, 
abdomen, thighs, popliteal spaces, shins, ankles, palms, and soles. On his 
left arm is a fine crust from a vaccination done twelve days ago. On the 
tattooed figure of liberty are scars of the four pustules named above. Ilis 
fauces are red and ulcerated; on the roof of his mouth are large mucous 
patches, and others on his gums. His tongue is swollen, ridged, and fur- 
rowed, and has on its left edge a mucous patch. The supra-trochlear 
glands in both arms are enlarged. Ilis general condition is bad ; he is 
sleepless and miserable, suffering much with osteocopic pains. 
Case XXII William L., set. 21, Am., butcher; examined at the 
House of Correction Oct. 25 ; gives a good family and personal history; 14 
is of healthy general appearance. Ilis statements are clear and positive. 
In September of last year, on the occasion of his twentieth birthday, lie 
drank, and had intercourse with a prostitute. Ten or fifteen days later, 
without any other exposure, lie noticed, on the left side of his glans penis, 
a sore, which a friend told him was a “ chancre.” This soon became an 
ulcer, and he got some nitrate of silver and cauterized it. He took no 
other measures in this connection. The crusts which formed upon the 
ulcer adhered to his shirt, and were a number of times pulled off’. Once, 
when the sore was a week or two old, lie had intercourse with a woman, 
and the crust came off and remained in her vagina. In a few weeks the 
ulcer healed. Upon careful and exhaustive inquiry lie states that he had 
no subsequent lymphatic or cutaneous evidence of syphilis. However, he 
suffered all the following winter with tonsillar enlargement, which he be- 
lieved to be mumps, and which was much relieved by a gargle of vinegar 
and cayenne pepper. In February of this year—five months after the 
sore on his penis—there appeared on the outer aspect Af his right thigh, 
about nine inches below the position of the trochanter major, a sort of a 
blister, which spread to a diameter of about an inch and became encrusted. 
Some weeks later a similar but smaller ulcer formed six inches higher 
on his thigh. After trying in vain to heal it by poulticing he went, on 
April 27, to the Philadelphia Hospital, where he was admitted to the 
venereal ward. Here the sores were diagnosed as syphilitic rupia; the 
crusts, which are described by the interne, Dr. Oliver, as like a tortoise- 
shell and of a dirty blackish-brown colour, came off; local cauterization 
with nitric acid was used, and the protiodide of mercury administered 
internally. In about a month the ulcers, were healed. 
About the end of June, while acting as an assistant in the hospital, he 
was tattooed by Kelly on the flexor aspect of the left forearm. The figure 
was a crucifixion, the pigments India ink and vermilion, both of which 
were moistened solely with the tattooer’s saliva. There followed slight and 
transient local inflammation, requiring no special treatment. In ten days 
he noticed three sores upon the tattooed figure, one on the right hand, one 
on the left shoulder, and one on the left wrist. These, he says, were like 
the bite of a “ mosquito or bedbug.” They itched, but were not scratched for 
fear of “poisoning” them. They soon secreted pus, and became ulcerated. 
In about a week an axillary bubo formed. lie now became alarmed, and 
consulted Dr. Oliver, who describes the sores as small papules, situated 
on a plainly indurated base, with an areola which faded out toward the 
circumference. They soon developed into pustules, and later into excavated 
ulcers, which were cauterized with nitric acid, after which they became 
encrusted. At the time of cauterization he was placed upon anti-syphilitic 
treatment. lie now permitted Kelly to tattoo both his upper arms, but 
made him mix his pigments with water. No evil results followed these 
operations. lie noticed no evidences of secondary syphilis until two 
months later, when there appeared papules in his nose and mucous patches 
in his mouth. 
At the time of our examination, four months after the tattooing, we find 
on his left forearm three hypertrophic papules covered with thick adherent 
scales, and surrounded by areas of thin bluish skin. These are the remains 
of the primary lesions described above, and are the exact counterpart of 
what we found on many of the other patients of this class. On his body 
are remains of a beautiful macular syphiloderm, of which lie says he was 
not aware when it came. There are some papules in his nose, and many 15 
in his palms anti soles. lie says there have been none on his genitals, 
lie has mucous patches in his mouth; an extensive one over the ascending 
ramus of the right maxilla inferior; one on the right side of the lower lip; 
and a number of small ones on the roof of his mouth. The only adenitis 
we can find is atrifing enlargement of both supra-trochlear glands ; perhaps a 
slight enlargement of the right inguinal glands, and in his left axilla remains 
of the bubo. He has marked alopecia, and complains of severe muscular 
pains as well as of pains in his bones. On the left side of his glans penis 
is a small teat-like scar, which when pinched gives a feeling of slight in- 
duration. Upon his right thigh are the scars of the sores which he con- 
nects with his chancre acquired in September 1870. The lower or earlier 
one presents a thin-skinned, elevated, slightly indurated, ham-coloured 
surface, oval in shape, about three-quarters of an inch in its longer, and 
half an inch in its shorter diameter, having extending to a distance of half 
an inch from its margin, all round, an areola of thin dusky skin. The 
upper or later lesion is similar in character, but smaller. The inner ele- 
vated and indurated part is less than a centimetre, and the total, including 
areola, about half an inch in diameter. 
There is some difficulty in assigning this case its proper place; but wTe 
conclude it is one where syphilis was communicated by the tattooing, in 
spite of the singularly clear and honest statement of the patient in regard 
to his previous history, and in spite of the scar on his penis, the sore- 
throat, and the appearance of the lesions occurring after what he himself 
believed an infecting or true chancre, and which he believed to be syphilis. 
This conclusion depends upon the patient’s positive and distinct statement 
that these two, the sore-throat and the ulcers on his thigh, were the only 
things simulating secondary syphilis which he observed. He had after his 
chancre no bubo, no eruption, no crusts in his head, no alopecia, no iritis. 
When to this we add the history and appearance of the lesion which fol- 
lowed his tattooing, and the condition in which he is at the time of our 
examination, we are brought to the conclusion, partly stated above, that 
his lesion last September was a chancroid—not a chancre—that his sore- 
throat was probably a tonsillitis, and that the ulcers in his leg were prob- 
ably ecthyma, and not rupia, as at first sight they might appear. Conse- 
quently we include the case among those in which syphilis was for the 
first time communicated by the tattooing. 
Resume—These fifteen cases of Class III. present a number of points 
of great interest which we will examine, so far as possible, in their natural 
order. 
The first of these points is in regard to the method of inoculation. In 
every case we find that the needles used for tattooing were repeatedly in- 
serted in Kelly’s mouth; saliva was used to moisten at least one of the 
pigments. Can we then say the saliva was the contagion? No; for we 
find equally that all the cases in Class I., who never had syphilis, and 
present as yet no evidence of it since their tattooing, were exposed to ap- 
parently as great risk of infection; and must conclude that we have not 16 
here any ground to doubt the general belief that the unmixed salivary 
secretion cannot communicate syphilis. 
On the other hand, the existence and the special location of the mucous 
patches in Kelly’s mouth seem to offer a reasonable and satisfactory ex- 
planation of the effects of his tattooing. Nothing is more probable than 
that, in the repeated application of the needles to his lips, the sucking, the 
wetting of them, they in most cases bore away virus from the lesions 
which were so conveniently situated for this ; while, also, nothing is 
easier to suppose than that the immunity in some cases was due to the 
fortuitous absence of this virus. 
A question might suggest itself as to the influence of tobacco juice 
mingled with the virus. From our examination of the cases here given 
we are led personally to the opinion that it did not have any, either in 
diminishing or increasing its activity. 
In Cases XII. and XY. we have beautifully contrasted the innocence 
of tattooing with water, and the serious result when the saliva was used. 
We frequently observed that when one pigment was mixed with water and 
the other with saliva, the primary lesion had its origin unmistakably where 
the latter was used. 
In the immediate effects we find considerable variety, but in none any 
specific evidence of a constitutional infection; this comes out first with the 
appearance, after a period of incubation varying from one to seven weeks, 
of a lesion which is of the utmost interest for us. 
What was this primary lesion ? Our inquiry (in which we particularly 
avoided asking leading questions) secured answers which, though varied, 
were unmistakable. Some compared the first manifestation to a pimple, 
some to a mosquito or bedbug bite, and one to “a pill under the skin;” 
all presenting the essential characteristics of local swelling and induration 
which mark a papule. In most cases this papule, like any other of its 
class, passed on, under accidental influences, to excoriation, ulceration, or 
pustulation; yet in one remarkable instance (Case XX.) there were none 
of these modifications, but from first to last only and simply papules. 
In other words, these cases present a beautiful illustration of the nature 
and progress of a chancre, which we would define as in the beginning a 
papule excited by a specific irritant, undergoing modifications as varied as 
the circumstances in which it is placed, and followed sooner or later by 
other manifestations of syphilis. (This is the only sense in which the 
term is used by us.) 
The theory of Diday, that the initial lesion of syphilis, contracted from 
the virus of a secondary manifestation, is an excoriated sore as contrasted 
with the ulcerated form when the poison was primary, does not seem sup- 
ported by the facts of this series of cases; for, on the contrary, we find 
every variety, from the simple, unabraded papule to the deep and multiple 
ulcer. 17 
The multiplicity of the initial lesion in some of these cases is not re- 
markable when we consider the means of inoculation. 
The varying terms of incubation of the primary lesion—from one to 
seven weeks—as well as those of the secondary manifestations—from one 
to six weeks more—may or may not have been what the patients stated. 
We have no means of correcting their statements, and can only reproduce 
them with this explanation, and without attempting any generalizations 
founded upon them. 
After the appearance of the initial lesion there was, then, a period of 
incubation varying, as the patients believed, from one week to six weeks, 
followed by— 
The manifestations of “secondary” syphilis In three cases these 
were ushered in by fever and malaise; in one the glands just below the 
bend of the elbow were enlarged; in five the supra-trochlear gland (gland 
of Ricord). In three cases there was reddening, and in one persistent 
whipcord-like induration of a lymphatic vessel. In six cases the glands 
in the axilla were involved. It is noticeable that in one case the axillary 
bubo suppurated and discharged spontaneously—an example of the rare 
but possible occurrence of a suppurating bubo following a chancre. There 
were four cases in which we could not satisfy ourselves of the implication 
of near lymphatic glands. 
Following or accompanying this stage we find the manifestation of 
syphilis on the cutaneous and mucous surfaces. Of the earlier and more 
transient forms—erythema, macula;, and squamae—we found it in some 
cases difficult to obtain any satisfactory evidence ; in some, however, we 
found distinct traces, though the patients themselves had not been aware 
of their occurrence. But when we looked for the papular eruptions there 
was no such difficulty. The history was well impressed on the patients’ 
minds, and the present evidence often only too obvious. A glance over 
the summary shows that these were, in most cases, of an extremely grave 
character. In twelve of the fifteen cases there were mifcous patches or 
ulcers in the mouth. In one the patches were very numerous, and in two 
both numerous and extensive. In one case there wras a fissure of' the angle 
of the mouth. In ten cases there were condylomata, which were, in one 
of them, immense. In one case there was well-marked impetigo on the 
forehead and lips. In one there was iritis; in nine post-cervical, in two 
post-auricular, in six inguinal, in five submaxillary, adepitis. In seven 
cases there was alopecia, and in three osteocopic pains. 
A noteworthy point seems to us the frequency with which the papules 
were located on the penis and scrotum. This occurred in twelve cases, in 
seven of which the number was very great. In many the papules situated 
on and within the prepuce, and about the corona glandis penis, were in 
their physical features exactly like chancres. (See, for example, Case 
VII.) In twelve cases there were papules developed in the soles, and in 18 
ten in the palms. In seven they were developed in the nasal cavity, 
becoming a cause of grave annoyance. In two there were papules in the 
external auditory meatus. 
The result of auto-inoculation, practised on two patients who had plain 
manifestations of syphilis, was as follows :— 
Case XV—On September 19th we scraped, with a tenotome, a little 
secretion from the primary lesion on his right arm, and inserted it in his 
left upper arm by scarification. This was covered with a watch crystal, 
held in place by a fenestrated band of adhesive plaster. 
The second day there was a slight reddening of the part scarified, and 
apparently a little thin serous secretion under the glass. The third day 
both these seemed greater. The fourth day the epidermis was elevated and 
macerated, and a superficial ulceration, about a sixth of an inch in diameter, 
beginning. Over this was the grayish-white coating of epidermis; around 
it was a narrow areola. It was moist, and gave material pain. The 
fifth day the areola was less; the ulcer about the same. The sixth day 
there was scarcely any areola; but the ulcer was deeper. The seventh 
day the areola was apparently unchanged; but the ulcer acquiring an 
irregular edge, and having a thin deposit covering it. The eighth day 
the ulcer was reduced in size, and the areola had disappeared. The 
ninth day no observation was made. The tenth day the ulcer was almost 
healed; but the patient complained of much pain. So the glass was 
removed, and we found its upper and lower edge had cut into the skin, 
making with the irritation of the secretions of the nicer, two others, 
linear and ugly, each about three-quarters of an inch long, and just like 
their predecessor in character. 
As we did not think the study of these would add any material point 
to that of the one we had made designedly, we applied to them, and the 
trace of it that was left, lotio nigra, under which all healed up nicely in 
three or four days more. 
Case XII On September 25th we scraped off, with a tenotome, a little 
of the secretion of the primary lesion on his right arm, and attempted to 
insert it in the left forearm by a simple puncture, in which we turned the 
point once around. In covering the spot with a watch glass we avoided 
the danger of producing such trouble as we had in the other case, by in- 
closing the glass between two fenestrated strips of plaster, placed face to 
face, of which the outer or upper was longer than the inner, and tailed— 
the tails serving to fix the whole, and keep it in position. 
The patient was under observation for about two weeks longer, at the 
end of which time he eloped from the hospital. So far the result was 
entirely negative, save perhaps an insignificant reddening of the point of 
puncture the day after it was made. 
In reviewing these two cases, we find, in the former the virus from a 
primary syphilitic lesion—a chancre—producing by auto-inoculation an 
ulcer presenting the features of a so-called chancroid. 
Upon the apparently negative result in the second case we do not think 
anything can be predicated, for the time of observation was too limited ; 
and, besides, we have no right to assume that the inoculation was success 
fully executed. 19 
The theoretical conclusions of our investigation are, we think, indis- 
putably confirmatory of the view that the virus from secondary syphilitic 
manifestations is in a high degree inoculable, that the primary lesion 
jollowing such inoculation is a true chancre, and that with this begins 
constitutional syphilis, differing in no essential point from that contracted 
from a primary syphilitic lesion. 
The practical conclusions are inseparable from the theoretical, viz., that 
too great caution cannot be used lest by any means the virus of inoculable 
lesions be transferred to innocent persons. The hands of the surgeon, his 
instruments, bandages, or other appliances should be most scrupulously 
cleaned after use about syphilitic patients. Dentists may especially take 
to heart this lesson, which is the more deeply impressed upon our minds, 
because, at this time, we are investigating a case where an unsuspecting 
woman was inoculated with syphilis of a most malignant type, while under 
a dentist’s hands. 
Tattooing, we think, might well be forbidden in the army and navy, as 
a useless and perhaps pernicious practice, one which may injure the men 
and prove an expense to the government, by bringing into hospitals and 
on the pension lists some who might otherwise be in active service. 
We think, too, that no false sentiment should prevent the distribution 
of such warning to the community as shall acquaint them with the sources 
of danger alluded to, as well as the possibility of syphilitic inoculation in 
the acts of kissing, nursing, using in common table utensils, towels, or 
anything which may come into contact with a syphilitic lesion.