Diagnosis 771 



injection with a fine needle, an erythema appeared, but faded within 

 forty-eight hours, the skin resuming its normal appearance, but 

 when it was applied to the ear of a syphilized rabbit, at the end of 

 the forty-eight hours the redness developed into an induration the 

 size of a pea and persisted from four to six days, disappearing in 

 ten days. In one case a sterile pustule developed. 



Luetin was tested by Noguchi and his colleagues upon 400 cases:- 

 146 of these were controls, 177 syphihtics, and 77 paras3rphilitics. 

 In the controls there was erythema without pain or itching, which 

 disappeared without induration within forty-eight hours. In the' 

 syphihtics at the end of forty-eight hours there was an induration 

 in the forni of a papule 5 to 10 mm. in diameter, surrounded by a- 

 zone of redness and telangiectasis. This .slowly increased for three 

 or four days and became dark bluish red. It usually disappeared 

 in about a week. Sometimes the papule underwent vesiculation 

 and sometimes pustulation. It always healed kindly without in- 

 duration. In certain cases described as torpid, the erythema cleared 

 away and a negative r'esult was supposed to have resulted, when 

 suddenly the spots lighted up again and progressed to vesiculation 

 or pustulation. In 3 cases there were constitutional symptoms — ■ 

 malaise, loss of appetite, and diarrhea. Noguchi found that the 

 reaction is specific, that it is most striking and most constantly 

 present in tertiary, latent tertiary, and congenital syphilis. It, 

 therefore, forms a valuable adjunct to diagnosis, seeing that it is 

 mo^t evident in precisely those cases in which the Wassermann 

 reaction is most apt to fail. A few early cases energetically treated 

 with mercury and salvarsan give marked reactions. A few old 

 cases fail to give it. 



SPIROCHiETA REFRINGENS (ScHAUDINN AND HOFFMANN) 



This spiral organism, though given the name by which it is now known by 

 Schaudinn and HoflEmann, was probably first described by-Donne under the name- 

 Vibrio lineola. It is probably a frequent organism of the skin and mucous mem- 

 branes, and occurs in greatest numbers in lesions of the genitalia because of the 

 smegma upon which it customarily lives. 



Pathogenesis. — It is present in most primary lesions of sjrphilis, but is no less 

 frequently found in non-syphilitic lesions, such as balanitis, venereal warts, 

 and genital carcinoma. It has also been found in the mouth and on the tonsils. 

 According to Hoffmann and Prowazek* it is not entirely harmless, and some of 

 the complicating lesions of syphilis as well as some of the destructive diseases 

 of the genitals may be intensified by it. They found it pathogenic for apes. 



Morphology.-^lt is much broader than Treponema pallidum, its spiral waves 

 are much coarser and less regular. 



Staining. — ^It is easy to stain by all methods and is hence easily found. It 

 does not stain by Gram's method. 



Cultivation. — It has been cultivated by Noguchi, f in acetic fluid agar-agar in 

 which it grows but when a small fragment of sterile tissue is added. No mul- 

 tiplication of the organisms takes place except under anaerobic conditions. The 

 isolation of the organism in pure culture is not easy but can be effected by the 

 means employed for Treponema pallidum. 



* "Centralbl. f. Bakt.," etc., 1906, xli. 



t "Journal of Experimental Medicine," May i, 1912, XV. 



