COMPLEMENT FIXATION IN SYPHILIS 421 



state the number of days that ehipsed from the appearanee of the 

 ])rimai'y lesion until the blood was taken for serologieal examina- 

 tion. 



The value of the Kline (1931) floeculation test of exudates ob- 

 tained from the primary lesion is yet to be determined. 



Secondary Stage. — Time of Appearance of Symptoms, Labora- 

 tory Findings and Duration. — The secondary stage of the disease 

 makes its appearanee about four to six weeks after the develop- 

 ment of the primary lesion. It is spoken of as the stage of gen- 

 eralized infection and is characterized by fever, rash, sore tliroat, 

 a more extensive involvement of the lymphatics, and a secondary 

 anemia. Other secondary manifestations such as alopecia (loss of 

 hair), mucous patches, etc., may occur. The spirochetes are widely 

 disseminated in the body at the time the secondary lesions appear 

 and are present not only in the blood but also in all of the sec- 

 ondary lesions. Syphilitic reagin is found in the blood in 85 to 90 

 per cent of individuals during the secondary stage of the disease 

 wliere treatment has not been instituted. 



Complement Fixation and Precipitin Tests in Untreated 

 Cases and Treated Cases. — Denison and McDonald (1933) report 

 positive serological findings in 85.2 per cent of 108 untreated and 

 46.3 per cent of 54 treated patients showing secondary manifesta- 

 tions. In this series the Kolmer complement fixation test was 

 positive in 81.6 per cent and the Kahn in 85.4 per cent of the 

 untreated cases. In the treated cases the former was positive 

 in 40.7 per cent and the latter (Kahn) in 48.2 per cent. Roby 

 (1933) believes that all untreated cases of secondary syphilis will 

 be found positive by the Wassermann test. 



It is stated frequently that the secondary stage lasts about two 

 years. This, however, is subject to considerable variation. As 

 the acute symptoms subside, the organisms disappear from the 

 general circulation and become localized in one or more tissues. 

 The lesions that subsequently develop give rise to the symptoms of 

 tertiary syphilis. 



Syphilis May Clinically Resemble Almost Any Disease. — It is 

 generally appreciated by clinicians that s^-philis may manifest it- 

 self clinically in such diverse ways as to resemble almost any other 

 known disease. This is well expressed in the saying of Osier, 



