Gummatous syphilide, with ulceration and necrosis of frontal bone
If you’ve ever wondered how someone could live with a skull like this one.
Tertiary syphilis would arise between three to 15 years after infection, and emerged as “gummatous” (forming gummas, soft tumor-like nodules, like what caused this lady’s ulcer) about 15% of the time. If the inflammatory nodules didn’t form on an important organ or blood vessel (as they could, and did, form anywhere in the body), gummatous syphilis wasn’t in and of itself fatal. Death from infected ulcers was not uncommon, however.
Interestingly, you could have gone to town with this lady and not gotten syphilis from her, despite her having been infected for probably more than half her life - tertiary syphilis is no longer transmissible.
A Practical Treatise on Diseases of the Skin. John V. Shoemaker, 1892.