SYPHILIS gi 



Vaccine treatment is of the highest possible value in the compli- 

 cations such as arthritis or iritis, but of much less use, if any, in 

 the primary disease, whether acute or chronic. Where indicated, 

 the dose should be small to commence with, say 5 millions, as 

 some patients show a very marked hypersensitiveness to the 

 vaccine ; but it should be increased rapidly until a definite reac- 

 tion shows that the limit of sensitiveness is reached. This may 

 not occur until as much as 500 millions are given. 



SYPHILIS 



It has now been abundantly proved that the Spirochceta pallida 

 (or Treponema pallidum) of Schaudinn is the actual cause of syphilis, 

 and the diagnosis of this disease by the recognition of the causative 

 agent is now practicable in some cases. The organism is a 

 spirochsete, in shape resembling a spirillum, but probably of animal 

 nature {i.e., a protozoon). It is very small, or rather very narrow, 

 and stains with great difficulty : it is this fact which has led to its 

 having been overlooked previously. In length it is about equal to 

 the diameter of a red corpuscle, either more or less ; it is made up 

 of about eight or ten close-set curves, and it has sharp ends. These 

 facts are very important, for there are numerous spirochaetes, 

 somewhat similar in appearance, which are frequently found in 

 ulcers of all sorts, in the mouth, etc., and which have no doubt 

 been frequently mistaken for Schaudinn's organism. The main 

 difference is that in the other common spirochetes (one of 

 which, the commonest, is called 5. refringens, and is closely 

 allied to, or identical with, that of Vincent) the curves are wider. 

 For example, if we found two spirochsetes exactly as long as a 

 red corpuscle is wide, and in one there were eight complete curves 

 and in the latter only three or four, the former would probably be 

 pallida, the latter refringens (Plate V.). The former is also said 

 to look stiffer and to be less easily bent. The staining reactions 

 are different in the two cases, refringens being stained, though not 

 deeply, with borax-methylene blue or dilute carbol fuchsin, whilst 

 the latter is not. 



Method. — The examination may be carried out on scrapings 

 from a supposed chancre, secondary ulcer, condyloma, etc. ; on 

 juice obtained from an enlarged lymphatic gland by puncture with 

 a hypodermic needle ; on the blood expressed from a secondary 

 rash after puncture of the skin, or, according to some authors, in 



