422 IMMUNOLOGY 



''Know syphilis in all its manifestations and relations and all 

 other things clinical will be added unto you." It is obvious that 

 any brief description of syphilitic manifestations such as is given 

 in this chapter is exceedingly inadequate and Ls mentioned only 

 to enable the student to appreciate the function, value and sig- 

 nificance of laboratory tests in the diagnosis of syphilis. 



Syphilis Charactemed by Periods of Latency Followed by 

 Periods of Activity. — The disease is also especially characterized 

 by periods of latency followed by development of symptoms. 

 Thus the onset of the tertiary stage is given as from two to ten 

 years or more after infection, although it has been reported as 

 early as six months. Its duration is not limited to any number 

 of months or years. Periods of quiescence and recurrence are 

 common. The symptoms are due to chronic inflammation of 

 various tissues. A very common tertiary lesion is the gumma 

 which resembles the tubercle of tulierculosis. It is a granuloma 

 due to infection and may occur in any tissue of the body. Ter- 

 tiary lesions of the skin, mucous membranes, circulatory system 

 (aneurysms, endarteritis), lungs, etc., may also be observed. 



In the pregnant female, miscarriages commonly occur or there 

 may be intrauterine infection of the fetus without miscarriage, 

 but with resulting congenital manifestation. 



Serology of Umbilical Bloods. — Roby (1933) considers that the 

 results of umbilical blood Wassermann reactions may be relied 

 upon as an index of the presence or absence of syphilitic reagin 

 in the mother's blood at the time of labor. If the umbilical cord 

 Wassermann is positive, it indicates that the mother has and the 

 child may have syphilis. If the latter has the disease, it will con- 

 tinue to show a positive blood Wassermann. On the other hand, 

 if the reagin but not the spirochetes have been transmitted from 

 the mother, the child does not have syphilis and the blood Was- 

 sermann will become negative within two months. He states that 

 his results, obtained independently, are confirmatory of similar 

 data reported by Dunham (1932). 



Tertiary Syphilis. — Serological Findings. — During the tertiary 

 stage of the disease, negative serological tests for the presence of 

 syphilitic reagin in the blood are quite frequent. Denison and 

 McDonald report on 672 untreated and 1,408 treated cases of 

 tertiary syphilis. Of the untreated cases, 37.9 per cent gave posi- 



