Syphilis in the medical, medico-legal and sociological aspects

Front matter

Class RC 2-QI

Book Ji^i_

Copyright^?

Preface

Contagious diseases, as a menace to the individual by their method of spreading, and as a menace to the race by their transmitted hereditary taint, offer an interesting field of study to the physician. The physician, more than anyone else, must try to prevent their spreading, and must enlighten the people concerning their existence and their consequences, so that the necessary precautions may be taken to protect society. Syphilis, as an infectious and contagious disease, which is communicated to the healthy by inoculation, and is transmitted by heredity to the fetus, either kills the fetus in utero, or causes the child to come into the world a tainted creature, demands our attention as a subject for study of deepest interest.

The connection between syphilis and social relations is so little understood that the name of the disease alone is sufficient to cast a mark of dishonor on the man who has had the misfortune to be inoculated. The public in general, ignorant of causation, is unable to understand the difference between one innocently infected and one who exposes himself to infection through lack of morality. Indeed, we shall never expect to be understood by superstitious people who, with religious devotion, carry about a potato in their hip pocket, which they believe will absorb all their rheumatic humors, or by those who carry pieces of carbon left by the arc lights for the same superstitious purpose. Neither do we expect to be understood by those who, on account of their belief in occult virtues, wear an iron ring on their little finger, which they claim to be electric and able to cure them of all their rheumatic pains which may be the result of a gouty condition, or perhaps of an old neglected syphilis.

Whoever entertains such irrational views and such disproportionate hopes, is superstitious and incapable of realizing that when a man has an eruption on his face, although it may be of a syphilitic nature, the fault of the infection does not necessarily rest on the lack of morality of the person. A great many, ignorant of the manifestations of any disease of the skin, are likely to think any eruption on the face or on the hands the result of syphilis.

It is for this reason we have decided to publish a few sociological considerations on this dreadful disease, for the purpose of placing the man who is infected with syphilis in a true social light. In many viii PREFACE

cases the fault is with the man infected, who in a moment of forgetfulness, misled by his companions, may have been indiscreet, although his moral character is good and irreproachable. For a young man of this kind, contracting this disease is a lesson in life which will remain vivid in his memory. The fear of the disease and of its consequences makes him take care of himself, stop the use of alcoholic beverages, stop smoking; reforming him entirely.

We also find a large number of patients who have been accidentally infected with syphilis, cases which have been called syphilis insontium, where the disease has been contracted accidentally, or in the discharge of professional duties, as among physicians, dentists and midwives. In these cases the man or woman was infected, while he or she did not deserve such punishment, and syphilis must then be considered as a non-venereal disease.

Syphilis, through the lymph and blood vessels reaches any organ and any tissue of the human body, and remaining in the system, is capable of bringing about so peculiar an appearance of the features of the individual that it is easily discovered by the eye of a skillful physician. This was pointed out by Ferdinand Hebra as ein ganz speciiisches Gesicht. If this is true of the general appearance of the body and especially of the face, it must also be so of the general mental condition of the person affected, for syphilis does not spare the delicate structure of the nerve cells, especially those forming the gray matter of the brain, and we quite often see specific affections of the nervous system in all the periods of the evolution of syphilis. Just as syphilitic eruption leaves marks on the skin, any attack on the nervous system must leave traces which late in life will become more pronounced. Indeed, if a syphilitic child shows unmistakable signs of syphilis in his or her bones in a form of dactylitis, he or she must also show signs of affection of the nervous system, which may be revealed in its motor or psychical functions. It is not difficult to perceive anomalies in the motor function, but the psychical condition is frequently hidden and only those who are constantly in contact with such a person are able to perceive the alterations of the psychical sphere.

It is, therefore, easily understood that all these questions pertaining to the syphilitic alterations in the man who becomes infected, and to all his relations to his wife, to his family and to society, form a vast and important sociological study, which we shall carefully consider in all its details.

Part I ■ The Transmission Of Syphilis

CHAPTER PAGE

I. Historical Sketch of the Search for the Causal

Agent 3

II. Pathological Process of Infection 14

III. Modes of Infection 22

THE EVOLUTION OF SYPHILIS

IV. Primary Syphilis 28

V. Constitutional Syphilis 38

Affections of the skin 41

The skin appendages 52

Late syphilis of the skin 54

Other tissues and organs 56

Oro-pharyngeal cavity 60

Alimentary tract 65

The respiratory tract 6j

The heart and blood vessels J2

The liver, spleen and kidneys 79

The male genito-urinary organs 84

The female genito-urinary organs 89

The bones and joints 90

The muscles and bursas 101

VI. Syphilis of the Nervous System 105

The brain 105

The spinal cord 112

General syphilitic affections of the nervous system 116 ix x CONTENTS

CHAPTER PAGE

Locomotor ataxia 121

General paralysis 123

Syphilis of the organs of the special senses . . 127 VII. The Nature of Syphilis as Influenced by Other

Conditions 136

Causes of malignancy 136

Mixed infection 138

Tuberculosis 140

Alcohol 140

Tobacco 141

Other disease causes 142

Individual dangers from syphilis 143

VIII. Parasyphilitic Affections 152

IX. Influence of Syphilis Upon Other Diseases . . . 158

X. The Treatment of Syphilis 171

External treatment 177

Internal treatment .183

Injection treatment 189

Inunctions 195

Fumigation 202

Physiological action of mercury 205

Mercurial poisoning 211

Thermo-mineral baths 212

Iodides 213

Individual prophylaxis 223

XL The Transmission of Syphilis to the Offspring . 229

Direct transmission 229

By conception 235

Germinative infection 238

Congenital and hereditary syphilis 240

Maternal heredity 245

Maternal heredity alone 250

Sterility from syphilis 251

Syphilitic immunity 254

Symptoms and consequences of congenital and

hereditary syphilis 264

General treatment of congenital syphilis . . .271

Constitutional treatment of congenital syphilis . . 273

Prophylaxis 275

Retarded hereditary syphilis 284

Latency of inherited syphilis 293

Syphilis of the third generation 299

CONTENTS xi

Part II Chapter Page

I. Syphilis and Marriage 317

Syphilis as an impediment to marriage . . . . 317

Syphilis as cause of divorce 321

Damages in cases of syphilis 324

The medical secret 329

Professional ethics and syphilitic patients . . . 336

In reference to marriage and to family .... 338

II. Syphilis in Relation to Degeneracy 343

Degeneracy 352

Physical signs of degeneracy . . . -. . . 366

Syphilis and the decadence of populations . . . 370

Syphilis as a predisposing cause of crime . . . 392

Syphilis and sexual perversion 405

III. Syphilis and the Public Health . . . .. . . 412

Syphilis and life insurance 425

Public prophylaxis in regard to prostitution . . 439

Prostitution of minors 448

Causes of prostitution 452

Proxenetism and procuresses . . . . . . 456

Sanitary consequences 459

Prevention and coercion . . . . . . . . 463

Juvenile courts 465

Industrial schools 473

IV. The Regulation of Prostitution in the Public

Prophylaxis of Syphilis 480

ILLUSTRATIONS

PLATE F CING PAGE

I Trypanosoma lues . . . . . . .12

II Syphilitic roseola. — Roseola annularis . . . .42

III Large papular syphilide, hypertropic type. — Papulosqua-

mous syphilide four years after infection . . 46

IV Circinate syphilide of diffused type .... 48 V Pigmentation left by hemorrhagic papular syphilide . 50

VI Syphilis ulcerosa . . . . . . 52

VII Papular syphilide with gangrenous spots . . .56

VIII Phagadenic syphilitic ulcer with elephantiasis of the anus

IX Large papular syphilide. — Circinate papular syphilide . 64 X Syphilitic cutaneous gummata, ulcerated. (Syphilis tuberculo-ulcerosa). — Ulcerated gumma of the nose. — Destruction of the septum nasi and portion of superior lip from syphilitic gumma . . .68

XI Ulcus perforans. — Multiple ulcerated gummata . . 72

XII Twin boys from syphilitic parents, one infected and the

other healthy ....... 250

XIII Examples of Congenital Syphilis :

Large papular eruption. — Rupioid form ; child died of pneumonia. — Diatrophy of right hand and left arm; child died of eclampsia . . . . . 268

XIV Diatrophy of the fingers in a heredo-syphilide. — Ulcerated

gummata in a heredo-syphilide .... 306

XV Leon F. Czolgosz. — Stigmata of degeneracy in a criminal 402

XVI Francesco Gioli ........ 406

Xlll

PART I THE MEDICAL ASPECTS

PART I THE MEDICAL ASPECTS

THE TRANSMISSION OF SYPHILIS

I

HISTORICAL SKETCH OF THE SEARCH FOR THE CAUSAL AGENT

It is indeed astonishing to find authors who have denied the existence of the syphilitic virus, and others, like Brussais in France and Huber in Germany, who have even denied the existence of syphilis. There is no one to-day who could for a moment have a doubt concerning the contagiosity of syphilis and the inoculation of a healthy person by an infected one.

Although until lately science had not positively discovered the exact nature of the syphilitic virus, yet by its contagiosity, course, and symptoms, it was always believed to be due to a living germ. Many investigators had searched in the blood and in the secretions of syphilitic patients, they had often referred to the discovery of a peculiar living organism, but later on it had been found to be not at all characteristic of the syphilitic affections.

All the observations of this kind made before the founding of the science of modern bacteriology have remained as mere historical curiosities without scientific importance. To this category has to be referred the vibriolineola of Mueller and Donne, the micrococci of Hallier, Klotzsch, Salisbury and Bruhlkens, and the peculiar bodies of Losdorfer, which he claimed to have found in the blood of syphilitic persons. Observations afterwards made in the light of modern bacteriology also remained unsuccessful. It would take a long time to mention everyone who has believed that he has seen the syphilitic germ, and has tried to demonstrate its existence, from Klebs, 1879, to Petrone, Barduzzi and Marcus, 1884. Their results were unsatisfactory and contradictory; no one has succeeded in showing a constant form of micro-organism in the inflammatory productions or in the blood of syphilitic persons, neither have they succeeded in a positive inoculation of a culture in the lower animals. It was about the end of the same year, 1884, that Lustgarten x in a preliminary communication announced that he had detected a special bacillus in the syphilitic tissues by means of a peculiar method of staining. In the following year 2 he gave a more detailed description of this bacillus ,and of the staining method. Doutrelepont 3 and Schiitz followed in claiming the discovery of the bacillus of syphilis by a method of staining nearly identical to that of Lustgarten, and De Giacomi, Gottstein and Baumgarten stated that they had succeeded in finding bacilli in an initial lesion.

Lustgarten examined sixteen cases of different lesions, such as indurated chancres, mucous patches and gummata. The bacilli were found in very small numbers, and attempts at cultivation were not successful, while the last mentioned authors with the decolorizing method succeeded in detecting bacilli in an initial lesion, which with the Lustgarten method could not be found.

At this point Cornil 4 communicated to the Academy of Medicine of Paris that Alvares and Tauel had found in the smegma taken from a healthy person, bacilli, which reacted in the same manner with aniline dyes as the bacilli described by Lustgarten. Furthermore, the above named authors did not find the Lustgarten bacillus in scleroses and mucous patches of the mouth, and of a gumma of the lungs, but they found the organisms in the secretions of chancres, gummata, mucous patches, as well as in three cases of soft chancre, in the fluid of vesicles of herpes preputialis and in pemphigus vulgaris on the genitals of both sexes. In the smegma taken from the prepuce, from the large and small lips of the vulva, and from the region of the anus, the same bacilli were found which gave a similar reaction to those described by Lustgarten.

The same results were obtained by Klemperer, who at a meeting of the Berlin Medical Society confirmed the observations of Alvares and Tauel, giving in this way a blow to the specificity of these bacilli.

It would be a long and difficult task to mention all the observers and authors who have worked in this direction, men of great scientific ability, such as Dutrelepont, Matterstock and Bitter. Disse and Taguchi, Lingard and Eve, Andromico, Habercorn, Marcus, Mansurow, Leloir, Babes, Koeniger and Fordyce, 5 all believed they had

1 Wiener Med. Wochensch. 1884.

2 Wiener Med. Jahrbucher. 1885.

3 Doutrelepont. " Bacillen bei Syphilis," Deutsche Med. Wochensch. No. 19. 1885.

4 Cornil. Gazette des Hopitaux, No. 90, 1885.

5 John A. Fordyce. " A System of Genito-Urinary," etc., edited by Prince A. Morrow, p. 47.

SKETCH OF THE SEARCH FOR THE CAUSAL AGENT 5

succeeded in finding a peculiar bacillus in a few cases of syphilitic scleroses or in the tissues of the mucous patches.

Lately Jullien communicated to the Academy of Medicine of Paris the results of his investigations made with the co-operation of Dr. Delisle in the Pasteur Institute. He demonstrated the presence of an aneroid bacillus in the blood of syphilitic patients. He was able to cultivate the bacillus in blood serum, and to inoculate different lower animals, finding that frogs and pigs showed great sensitiveness to this poison.

Max Yon Niessen 6 had also described a bacillus which he claimed to have found in the blood of syphilitic persons, which grows on nutrose agar, the color of which changes into yellow and yellowish green. It is colored by the staining method of Gram Nicolle. He claims to have found the same bacillus in all stages of syphilis. He inoculated monkeys and pigs with the cultures of this bacillus. The monkeys soon died after the inoculation, some showing diffuse erythema and inflammation of the lymphatic glands. In one monkey which remained alive for some time, a form of hepatitis developed with hypertrophy of the capsule of the liver and under the microscope the blood-vessels showed the same appearance as in man. Another monkey after a certain time was affected with epileptiform attacks. He spoke of papular eruptions, sclerosis, gummata and also of periostitis developed in the pigs. Although the observations were of great interest, and the article was beautifully written, yet it was severely criticised by Ludwig Walsch of Prague in the Archiv fur Dermatologie und Syphilis, July, 1901. Walsch showed a lack of proof in Von Niessen's findings, premature conclusions from the results of his inoculations, and inconsistency of his projected therapeutics.

Max Joseph 7 made a communication to the Berliner Medisinischen Gesellschaft, with illustrations, showing some peculiar bacilli found in the sperma of syphilitic patients at the height of the infectious period. The work was done in Dr. Piorkowski's Bacteriological Institute in Berlin, and was followed by another lengthy communication by Dr. Joseph at the meeting of the Deutscher Natur-f or sellers und Aerzte in Karlsbad, September 24, 1902.

Joseph started with the idea that a man who has been infected with syphilis, after two or three years, while apparently well, having sexual intercourse with a healthy woman, does not communicate the disease to her. But when the woman is fecundated, then the fetus is infected and communicates the disease to the mother. As a consequence he

6 Von Niessen. " Beitrage zur Syphilis Forschung," Wiesbaden. 1901. 'Joseph, Max. Berliner Klinische Wochenschrift. No. 13 and 14. 1902.

concluded that the syphilitic virus remains longer in the semen than in other secretions of the organism. He used sperma of syphilitic persons for inoculations, and as a culture medium pieces of sterilized placenta, which were inoculated mostly on the maternal side, and were kept in an incubator at the temperature of 37 C°. After twenty-four to forty-eight hours he could see on the inoculated places small points, grayish in color, which were colonies of micro-organisms which he recognized as bacilli. He compared these bacilli with those of diphtheria, and they were easily stained with carbolfucsin and gentian violet. He claimed to have found these bacilli in many cases of syphilitic persons five years after infection, although they had undergone several treatments. He found the same bacilli in the tissues of the hard chancre, but he never could find them in the chancroid, or in simple erosions of the genitals. The bacilli were also present in ulcerated mucous patches of the scrotum, of the vulva and of the mouth. He claimed to have obtained positive results from the inoculation of pieces of inguinal glands, which had been removed from the groins of syphilitic patients under the strictest asepsis.

Joseph bases the specificity of these bacilli on their peculiar shape, and on their peculiarity of vegetating only on the placenta as a culture medium. The cultures of these bacilli were inoculated on rabbits and guinea pigs without any results, but it seems that in a pig, several days after inoculation, an erythematous eruption appeared around the genitals, with ulcerations. The pig died and the lymphatic glands were found greatly hardened and swollen. But on the other hand another pig inoculated with different cultures proceeding from syphilitic tissues did not show after several months any perceptible alterations.

He showed many preparations of the bacilli and explained the method of staining, which is a combination of Ziehl-Neilsen's method. The specimens first imbedded in paraffin are cut in thin sections and are placed in xylol for twenty-four hours, then in seventy per cent, and in absolute alcohol. The section is placed on the glass slide and dried with blotting paper, and kept for four hours in a solution of diluted carbol-fuchsin, then it is placed in a mixture of water and alcohol with three per cent, nitric acid. It is dried again and stained with Loffier's methyl-blue solution for a few minutes, then washed, dried and mounted in Canada balsam.

In the examination of the lymph glands he claims that the bacilli are very numerous in the middle, in the lymph spaces, and very few towards the periphery.

This announcement of having found the so much searched for bacillus of syphilis caused the same objections among the scientists as

SKETCH OF THE SEARCH FOR THE CAUSAL AGENT 7

in the ether cases. Delbanco 8 referred to the observations made by H. Pfeiffer in fifteen normal urethrae and in twelve affected with gonorrhea, by means of preparations on the cover glass, and by means of culture. In these preparations he found a large number of bacteria belonging to the group of pseudo-diphtheritic bacilli. Not one of the men furnishing the material for examination was syphilitic. The morphological appearance of those bacilli was exactly the same as that of those described by Joseph and Piorkowski as syphilis bacilli, and yet they are only an innocent kind of parasite, which have been mixed with the sperma while passing through the urethra. The only part difficult to be explained was the presence of the bacilli in the swollen syphilitic glands, found by Max Joseph in two instances.

Paulsen, 9 at the biological section of the Medical Association of Hamburg, had already demonstrated bacilli having a great resemblance to those of diphtheria in cultures of the blood taken from the forearm of a man covered with syphilitic roseola, and once from the lymph taken from the swollen lymphatic glands of the groins, while the initial chancre was still present. The bacilli, although showing great likeness to those of diphtheria, have many characteristics which differentiate them. Paulsen limited himself to announcing the fact without deducing any conclusion.

In 1884 Loffler, while treating the subject of diphtheria in calves, referred to a bacillus which he had obtained by inoculating rabbits with products from syphilitic lesions. This bacillus is morphologically similar to that of diphtheria of calves. From his experiments he concluded that, on the raw surface of mucous patches, parasitic bacilli find a good ground for their development.

When in September, 1902, at a meeting of the Carlsbad physicians, Joseph and Piorkowski read their second communication, " Weitere Beitrage zur Lehre von den Syphilis-bacillen," Walsch spoke of his observations of the presence of the v. Niessen bacillus. He found this bacillus in six instances in the blood of syphilitic persons during the secondary period and also a yellowish diplococcus, which he had found three times. He had obtained the same bacilli in the culture of the serum taken from the inguinal glands removed from syphilitic patients. The blood taken from healthy people, and from syphilitic persons in the tertiary stage remained negative.

From the blood of patients affected with syphilitic roseola, which had been inoculated on organs taken from the pig, bacilli were obtained, which had been described by v. Niessen, and had afterwards

8 Delbanco, Ernst. " Einige Notizen zu dem Aufsatz von H. Pfeiffer: Ueber Bakterienbefunde in der normalen mannlichen Urethra mid den Syphilis Bacillus von Max Joseph." Monatsh. fur Prakt. Dermatologie. 1903, No. 5.

9 Paulsen. Munch. Med. Wochenschr. 1902, No. 9.

been found by Adrian, Holzhauser and Hiigel. Walsch considered the bacilli found by himself, and those found by Joseph" and Piorkowski as pseudodiphtheritic bacilli, which so far do not throw any light on the obscure etiology of syphilis.

Delbanco maintained the same opinion, and he believes that the bacilli alleged to be the cause of syphilis are only pseudodiphtheritic bacilli, which ought to be called bacilli found in syphilitic persons. We must not forget that in syphilis the initial lesion is usually ulcerated, the moist papules are ulcerated, and all are open doors for the entrance of secondary bacilli, which are taken in by the lymphatics and carried into the glands, and are also brought into circulation in the different parts of the system. The same order of secondary bacilli is found in lepra. The claim of Joseph and Piorkowski to have found the bacillus causa proxima of syphilis, falls to the ground and the bacilli that they have demonstrated are the very same found by Pfeiffer, Paulsen, Walsch ; only a kind of diphtheroid bacilli, which are found in syphilitic patients as secondary bacilli.

Max Schiiller 10 described a peculiar form of round or oval bodies in the tissues of the syphilitic sclerosis, which he describes as forms of spores which appear closed in capsules. He finds that they are capable of some movements and compares them to a kind of sporozoa. In our pathological studies we have met with these peculiar forms, which are very visible when stained with Bismarck brown, made up of round bodies, which are nothing else than thrombi made up by an accumulation of leucocytes inside of the small lymphatics. We have already pointed out these conditions of the lymph-vessels in an article read to the meeting of the Fourteenth International Medical Congress in Madrid, 1903. We have found that the lymphatic vessels are affected by an inflammatory process, their endothelial cells are enlarged and in some places detached. The lymphatic vessels starting from the initial sclerosis are also enlarged and show irregular dilations during their course in the form of cul-de-sacs. They are filled with mononuclear leucocytes, which occlude the lymphatic vessels. The syphilitic virus seems to possess an agglutinating power on the serum and the leucocytes easily stick to the endothelial lining, so that the lymphatics are at times plugged up with lymphatic thrombi. We therefore refer the peculiar appearance in the form of stars composed of round bodies, to a thrombosed condition of the lymphatic vessels, cut in transverse section.

The question still remained sub judice. Everybody believed syphilis to be a disease of bacillary nature, and nobody doubted that the bacillus

10 Schiiller, Max. " Mitteilung iiber die protozoenahnlichen Parasiten bei Syphilis." Dermat. Zeitschrift, 1903, Heft 4.

SKETCH OF THE SEARCH FOR THE CAUSAL AGENT 9

would be found. One of the difficulties was that the syphilitic virus had not yet been successfully inoculated in animals, and in consequence was also refractory to inoculation on artificial culture media. In reference to the bacilli, which were claimed to be syphilis bacilli, and then shown to be smegma bacilli, Pizzini was of the opinion that they were probably tubercle bacilli, which if in a dormant state are easily aroused by the syphilitic virus. The morbid symptoms produced in animals by the inoculation of these cultures were in all probability only the result of acute tuberculosis.

In these last years a new era in the study of syphilis has begun, which indeed promises to cut asunder the veil which has enveloped the cause of the disease.

Metschnikoff and Roux 1X announced the discovery of the successful experimental transmission of syphilis in the monkey, and not much later the finding of the pathogenic agent in a form of spirillum by Schaudinn and Hoffmann was announced. Inoculation of syphilis in apes occurs in those of the anthropomorphous kind, as it was confirmed by Lassar 12 in a chimpanzee in the Aquarium in Berlin, and later by Neisser. From the experiments it was found that the chimpanzee is susceptible to infection with syphilis just as man. Twenty-two animals were inoculated, all with positive results. In any place where the inoculation has been done a characteristic syphilitic initial lesion has developed. The regions more often inoculated have been the brow or the eye-lid, which are more easily watched. The initial lesion has appeared between fifteen and forty-nine days after the inoculation, giving an average of thirty days of incubation. The initial lesion is not different from that which is seen in man, being in form of a small, hardened papular knot, bluish red in color, which soon is excoriated and then ulcerated, and covered with crust. After one or two months the lesion heals, the hardness gradually disappears and only a superficial cicatrix remains, stained with a brownish pigmentation. The anatomo-pathologic alterations of the lesion in the monkey is just the same as in man, as was shown by Lassar, Arnal, Salmon, Thibierge and Ravau. These consist in an infiltration of small mononuclear leucocytes surrounding especially the blood and lymph vessels, and in some cases true peri- and endoangioitis.

After the onset of the syphilitic initial lesion the lymph glands are hard and enlarged, at first near the lesion, soon after of the whole body.

In sixty-six per cent, of the inoculated animals, in from twenty

11 Metschnikoff and Roux. " Ueber die experimentelle Syphilis.'' Ref. Berlin Klin. Wochenschr. No. 52, 1903.

12 Lassar, O. " Ueber Impfversuche mit Syphilis am anthropoiden Affen." Derm. Zcitschr. Bd. xi.

to forty days from the first local lesion, general symptoms occur in the form of ulcerated papules of the genitals, of the chest, in the form of excoriated mucous patches of the mouth, papulo-squamous syphilides of the palms and soles. In the chimpanzee these symptoms, perfectly identical with those of man, are not so severe, are less extensive and of shorter duration. After three to four weeks they undergo an involutive process and disappear. In one instance only the eruption was of malignant form, of a rupioid nature, with extended ulcers ; the animal showed deep cachexia and soon after died.

Visceral complications in the animals such as a hypertrophic condition of the spleen and nervous disturbances, and paresis of the posterior limbs, with abolition of the knee jerk were found.

So far, no symptoms of late syphilis have been observed in the inoculated animals, because not one has lived more than thirteen months after the infection. Death has been caused in nearly all cases by infectious broncho-pneumonia.

Experiments were repeated in other kinds of apes, as in the gorilla and ourang-outang, but after the appearance of the initial lesion no general symptoms have followed. In the same way experimental inoculations were made in the macachous rhesus, speciosus, cynomolgus, cynocephalus, cercopithechus, fuliginous and ruber, in many different countries, with the same results. In every case the initial lesion has appeared, but no general cutaneous manifestations have followed. The glands surrounding the initial lesion have become enlarged, showing that the virus does not find an appropriate soil and soon is attenuated and dies.

We owe to the experimental researches of Neisser the confirmation of the knowledge already acquired from clinical observations, that the initial lesion and the mucous patches, as well as the cutaneous papules, are capable of transmitting the disease. He proved, furthermore, that the lymph glands and the serum from a bulla of syphilitic pemphigus in an infant with congenital syphilis could inoculate the disease.

It seemed that other organs, spleen, liver, marrow of bone, cerebrospinal fluid, had given negative results, but in successive inoculations in Batavia, Neisser succeeded in inoculating apes with these organs taken from other syphilitics.

In April, 1905, Schaudinn (unfortunately so soon lost to science and to humanity), then director of the laboratory for the study of the protozoa in the Berlin Institution, together with Hoffmann, lecturer on syphilology, announced the discovery of a micro-organism in the syphilitic products, which had never been described, belonging to the spirilla variety, difficult to stain, and from this peculiarity of taking little of the stain when treated with Giemsa's azur and eosin. they