DIAGNOSIS OF SYPHILIS 55 



are not reached by the drugs may flare up and produce a serious 

 attack after the spirochaetes in other parts of the body have 

 been killed and the skin lesions healed. On the other hand 

 paralytics with an active attack on the central nervous system 

 seldom show any other symptoms. Unborn babies seem not 

 to be subject to such specialized attacks, but, as already pointed 

 out, are often found with every organ and tissue in the body full 

 of spirochaetes. There is a form of the disease occurring in 

 adults known as " malignant syphilis " in which ulcerating sores 

 appear early and gradually eat away large portions of the skin. 

 It is marked by extreme anemia and great weakness, and usually 

 causes an early death. 



Diagnosis. The modern methods of diagnosing syphilitic 

 infection have revolutionized our knowledge of the disease, and 

 have done much toward placing its treatment and control on a 

 scientific basis. In at least 50 per cent of syphilitic cases there 

 are no symptoms which can be attributed positively to syphilis, 

 but we now have several tests for the disease, two of which are 

 of wide application, and, together with the characteristic lesions 

 in certain stages of the disease, make it possible to detect syphi- 

 lis in practically any phase. 



The simplest of these indicators for syphilis is the " luetin 

 test." This consists of the injection into the skin of a sterile 

 emulsion of the dead bodies of the spirochaetes from a culture. 

 If the test is positive, i.e., if syphilis is present, the inoculation 

 results in a solid or a pus-filled pimple, usually appearing in a 

 few hours but sometimes not for several days. This test is ap- 

 plicable to latent, tertiary and congenital syphilis and does not 

 give positive results during the active primary and secondary 

 stages of the disease. Its value lies in the fact that it is sometimes 

 sensitive to latent infections which the Wassermann reaction, 

 now to be described, does not demonstrate. 



The Wassermann reaction, although it fails to reveal syphilis 

 in rare cases, is one of the most valuable and dependable means 

 of diagnosis known in medicine. It is now almost universally 

 used in well-equipped laboratories. The reaction is also positive 

 to some other diseases, such as yaws (also a spirochaete disease), 

 leprosy, malaria, scarlet fever and other diseases, but all of 

 these can be diagnosed beyond doubt by other means and thus 

 prevent a false diagnosis of syphilis. The reaction in brief is as 



