Diagnosis 797 



from the primary lesion, in juice from the bubos and en- 

 larged lymph-nodes; in the blood, in the roseola, and all of 

 the secondary lesions, and sparingly in the tertiary lesions. 



In congenital syphilis they reach the fetus from either the 

 ovum, the spermatozoon, or from the blood of the mother. 

 Prenatal death from syphilis is accompanied by lesions in 

 which enormous numbers of the organisms can be found, 

 and furnishes the best tissues for their experimental demon- 

 stration and study. 



Lesions. The lesions of syphilis are so numerous that 

 the reader is referred to works on pathology and dermatology 

 for satisfactory descriptions. Here it may suffice to say 

 that though diverse in appearance and location, they have 

 certain features in common. The first of these, and that 

 which naturally places syphilis among the infectious granu- 

 lomata, is the lymphocytic infiltration of the tissues, with 

 which all of the lesions begin. The second is a peculiar 

 form of necrosis slimy when superficial, gummy when 

 deep with which they terminate. The third is a tendency 

 toward excessive cicatrization. 



Diagnosis. It is now possible to make a certain and 

 early diagnosis of syphilis by the recognition of the specific 

 organisms, and as the difficulty of treatment is in proportion 

 to the stage at which the disease arrives before treatment, 

 it should never be neglected. 



I. Staining. The expressed lymph from a carefully 

 cleaned freshly abraded primary lesion can be stained by 

 Giemsa's method, or, as is much better and more certain, by 

 Stern's method, with nitrate of silver, or by the use of India 

 ink. 



II. Dark-field Examination. For those who possess the 

 " dark-field illuminator " or some similar apparatus with 

 the proper lamp, direct examination of the fluid expressed 

 from the lesions can be made, and the living, moving organ- 

 isms recognized. This should be the quickest method of 

 diagnosis, though it takes practice. 



III. Serum Diagnosis. Wassermann and Bruck have 

 devised a laboratory method of making the diagnosis of 

 syphilis by testing the complement fixing power of the 

 patient's serum. This method, now known as the " Was- 

 sermann reaction," is given in complete detail under a more 

 appropriate heading. (See Wassermann Reaction.) 



The success of the von Pirquet cutaneous tuberculin re- 



