524 FKAMBCESIA OR YAWS 



are apparently contained in the globulin fraction ; but we 

 know nothing as to why this peculiar modification of the 

 serum should be present in syphilis. It is now generally' 

 accepted that it does not depend on the presence of an anti- 

 substance (immune-body), which in association with the antigen , 

 (the spirochsete) fixes complement. 



Methods of Examination. — As already said, in the examination of an 

 ulcerated chancre or other lesion it is advisable to get rid of the surface 

 organisms. The surface should lie cleaned with saline and dried. A 

 piece of cotton-wool soaked in absolute alcohol or spirit is then applied 

 for about a minute ; the alcohol is then washed off with saline, and the 

 surface is again dried. After a short time there is usually a free flow of 

 watery lymph, which is practically free from other organisms, and often 

 contains the spirochaete in large numbers ; a small drop of this is 

 placed on a slide, a cover-glass is applied, and the specimen is examined 

 by dark-ground illumination. It is advisable to put a thin ring of 

 vaseline on the slide to support the cover-glass. Dried films also may be 

 made and treated by any of the methods above described (p. 110), of 

 which Fontana's is to be recommended. Others prefer to scarify the 

 margin of the sore and examine the lymph which exudes, the flow of 

 which may be aided by squeezing, or a small incision may be made with 

 a very sharp knife, and then after bleeding has completely stopped to 

 take the small drop of serum which gathers at the site. In- all cases 

 admixture of blood is to be avoided, as it interferes with the examination 

 by the dark-ground method. In the case of a lymphatic gland or non- 

 ulcerated lesion it is best to puncture with a hypodermic needle, the point of 

 which should be moved aboutin the tissue. After it is withdrawn a little 

 saline may be placed in the syringe and pressed through the needle, the first 

 small drop which passes, and which washes out the contents, being taken 

 for examination ; here also dark-ground illumination gives the best results. 



For methods of cultivation, vide p. 520. 



Frambcesia ok Yaws. 



Frambcesia is a disease of the tropics, occurring in the west 

 coast of Africa, Ceylon, the West Indies, and other parts. 

 It is characterised by a peculiar cutaneous eruption, and it is 

 markedly contagious. Its resemblance in many respects to 

 syphilis has been noted, and the relation of the two diseases 

 has been the subject of much controversy. It is accordingly a 

 matter iof great interest that an organism of closely similar 

 characters to the spirochaete pallida has been found in the lesions 

 of frambcesia. This organism was discovered by Castellani, who 

 gave to it the name spirochaete pertenuis or pallidula. Morpho- 

 logically, it is practically identical with the spirochsete pallida ; 

 when ulceration has occurred other spirochsetes of less regular 

 form may be present as contaminations. In the skin lesions 

 it has been shown by Levaditi's method to be present in con- 



