Gummatous nipple (a.) and breast (b.)
A. The nipple was of a 29-year-old man who’d been afflicted with syphilis for 6 months. He’d been treated the entire time with a mercurial solution (the typical and most effective treatment of the day), but his entire body had still developed syphilitic ulcers over that time. The left nipple was completely replaced by an ulcerating sore, and he even had pustular sores with extensive crusts on his scalp. There was a pustulous ulcer within the nose and partially-healed sores all over the body. Patient was very emaciated and anemic.
B. The breast was of a 41-year-old woman who had 4 children, and had never breast-fed. She noticed a gradually-increasing tumor in the left breast appx one year before she was seen by this doctor. It began ulcerating approximately 6 months before admission. Upon examination, there were scars of healed papules around the anus, perineum, and labia majoris, and swelling of the inguinal glands. Her mouth, nose, and throat were all clear.
The differences in the two cases point out the unexpected ways people can react to the same disease. An able-bodied male can be incapacitated faster than an older mother of multiple children who was known to have had health problems in the past, even when he receives treatment from the first obvious signs of disease.
Some of the reason behind why that can happen has to do with the strength of the immune system of a given patient (affected by previous diseases, living conditions, and heredity), but just as much has to do with what strain or mutation of a disease was acquired, and sometimes reasons that we can’t explain even with modern medicine.
From Atlas of Syphilis and the Venereal Diseases, edited by L. Bolton Bangs, M.D., 1899.