152 MEDICAL BACTERIOLOGY 



of the difficulty of obtaining pure cultures of treponema pallidum, the almost 

 impossible feat of differentiating similar spirochseta from the treponema, and 

 the difficulty of keeping pure cultures from contamination. Toward the end 

 of the primary or early in the secondary stage of syphilis a number of properties 

 are demonstrable in the blood, which are not, practically speaking, found in the 

 blood of healthy or diseased persons free of syphilis. By far the most important 

 of these, from a diagnostic consideration, are amboceptors or complement fixing 

 .bodies. These are nearly always demonstrable when the disease is active and 

 are also demonstrable in the majority of latent cases. To detect the presence 

 or absence of these antibodies the Wassermann test is employed. 



Diagnosis. In the first stage of the disease ulcers and adjacent enlarged 

 glands should be examined for treponema and a Wassermann test made. A 

 negative Wassermann at this time has no significance. 



In the second stage of the disease a Wassermann test should be made, and, 

 if desired, papules, ulcers and enlarged glands adjacent to them may be examined 

 for treponema. 



At this time nearly all cases of syphilis give a positive Wassermann; a nega- 

 tive is suggestive of non-syphilitic nature of the malady. 



In the third stage of the disease the Wassermann test should be performed as 

 in the primary and secondary stages, and if negative the spinal fluid should then 

 be examined, because at this time a positive reaction may be obtained with the 

 spinal fluid, even though the blood is negative. 



EXAMINATION OF ULCERS FOR TREPONEMA PALLIDUM 



Wash the ulcer free of extraneous matter with sterile normal salt solution. 

 Avoid bleeding and scrape some material from the ulcer. Place a small por- 

 tion of the scrapings in a drop of salt solution on a slide, gently drop a cover 

 glass on it and lute with vaseline or paraffin. This should be examined with 

 the dark-field illuminator, or if that is not available, with a J^2 ou * immer- 

 sion objective and an 18 ocular. 



When the scrapings are obtained several slides should be prepared by spread- 

 ing thin, even films, drying them in air or in an incubator at 37C., if fixing in 

 alcohol and staining by Giemsa's method. 



If, in such preparations, an organism is observed that appears to be trepo- 

 nema pallidum, one should remember that a number of organisms, microscop- 

 ically indistinguishable from treponema pallidum, may be found in superficial 

 ulcers. 



Failure to find treponema pallidum in scrapings from ulcers and in fluid from 

 papules and glands does not indicate the absence of syphilis, as the organisms 

 are irregularly distributed and often scant in the material taken for examination. 



EXAMINATION OF GLANDS 



Enlarged glands should be searched for; if found, they are massaged, the 

 overlying skin asepticized and some of the glandular contents removed with a 

 sterile syringe for microscopic examination. When material so obtained con- 



