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The common assumption is that he has some version of a letter "A" on his chest, although it is not clearly stated in the text. Different scholars have different theories on how the letter "A" could have gotten there -- did he burn or carve it himself? Is some sort of guilt-induced occurrence? In Chapter 12, Dimmesdale seems to have pain on his chest implying that that the wound is self-inflicted, but Hawthorne does not make it clear.
There are references to what is on his chest in Chapters 10 and 12.
Hawthornes gives several suggestions. One is that there is nothing there, and that his pain was spiritual not physical. Another is that he might have carved an "A" there during his self-punishment in the closet. A third is that some sort of rash or sore came up on his chest caused by the stress of his secret. It really does not matter, because the "A" was not the issue, the sin was.
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