726 Syphilis 



be well. Should he continue to harbor some of the micro-parasites, 

 however, there may be an insidious sclerosis of the blood-vessels 

 and parenchymatous organs consequent upon the growth and mul- 

 tiplication of the parasites, or there may be after many years a 

 period of tertiary symptoms characterized by the sudden appear- 

 ance of severe lesions in which the parasites are very few in number. 



The specific organisms are present in juice expressed from the 

 primary lesion, in juice from the buboes and enlarged 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 the ovum, the 

 spermatozoon, or 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 demonstration 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 niay 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 granulomata, 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 diag- 

 nosis 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 organisms 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 test- 

 ing the complement fixing power of the patient's serum. This 

 method, now known as the "Wassermann reaction," {q.v.) is given 

 elsewhere in complete detail. 



The success of the von Pirquet cutaneous tuberculin reaction in 

 assisting the diagnosis of tuberculosis led to experiments on the 

 part of a number of investigators — Meirowsky, Wolff-Eisner, 

 Tedeschi, Nobe, Ciuflfo, Nicholas, Favre, and Gauthier and Jodas- 



