770 Syphilis 



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, Ciuffo, Nicholas, Favre, and Gauthier and Jodas-^ 

 sohn — to obtain analogous reaction in sj^philis by applying extracts 

 of syphilitic tissues to the scarified epiderm of syphilitics. Some 

 reactions were observed, but Neisser and Bruck found that similar 

 reactions occurred when a concentrated extract of normal liver 

 was applied, and to such reactions which could not be looked upon 

 as specific, Neisser applied the term " Umstimmung." 



After having successfully achieved the cultivation of Treponema 

 pallidum, Noguchi* resolved to try the effect of an appUcation of 

 an extract of the organisms applied to the skin, in the hope that it 

 might provoke a reaction useful for diagnosis. To this end he pre- 

 pared two cultures, one in ascitic fluid containing a piece of sterile 

 placenta, the other in ascitic fluid agar also containing a piece of 

 placenta. After permitting them to grow under strictly anaerobic 

 conditions at 37°C. until luxuriant development occurred, the lower 

 part of the solid culture was carefully cut off, the tissue fragment 

 removed, and the rich culture carefully ground in a sterile mortar, 

 the thick paste being diluted from time to time by adding a Uttle 

 of the fluid culture. The grinding was continued until the emulsion 

 became perfectly clear, when it was heated to 6o°C. for one hour upon a 

 water-bath and o. 5 per cent, of carbolic acid added. When examined 

 with the dark-field illuminator, 40 to 100 dead treponemata could 

 be seen in every field. Cultures made from the suspension remained 

 sterile and inoculation into rabbits' testicles was without result. 



This extract of the treponema culture he called luetin. When it 

 was applied to the ear of a normal rabbit, by means of an endermic 

 * "Journal of Experimental Medicine," 191 1, xni, p. 557- 



