GENERAL CHARACTERS OF SPIROCILETES. 55 



ber of cases a tertiary stage is met with, consisting in 

 the formation of localised inflammatory swellings, 

 which may occur in any part of the body (the so-called 

 gummas, from the "gummy" nature of the material 

 formed by breaking down of the inflammatory cells). 

 In these either no spirochsetes are found, or only a few 

 degenerate specimens. This stage is not infective. 



Malignant syphilis is the name applied to certain forms 

 of the disease in which ulcerative lesions appear at an 

 early stage. Anaemia and cachexia develop to a severe 

 degree, and the condition is not amenable to treatment 

 with mercury. It "must be distinguished from severe 

 syphilis which is characterised by dangerous localisa- 

 tion of the disease, or by association with other morbid 

 conditions. The cause of malignant syphilis is doubt- 

 ful; it has been attributed both to excessive virulence 

 of the microbe and to secondary infection with other 

 organisms. It would appear more probable that it is 

 due to the implantation of the microbe on virgin soil 

 i.e., on persons whose ancestors have been free from 

 syphilis" (C. F. Marshall 1 ). 



Infection is usually contracted in coitu and is con- 

 veyed by the discharge from the primary sore. It can 

 also be conveyed by means of drinking vessels or of 

 a tobacco pipe recently used by an infected person 

 in the secondary stage, in which there are infective 

 lesions in the mouth and throat. Thus, either direct 

 contact is necessary or very direct conveyance by an 

 intermediary object. Some abrasion of the skin is 

 probably required for the entrance of the infective 

 organism, and surgeons are often infected through 

 slight wounds in the fingers in the course of examining 

 syphilitic patients. Infection does not seem to arise 

 from contamination with the fluids of the dead body, 



1 " Syphilology and Venereal Disease," 1906, London, pp. 18-19. 



