SIGNIFICANCE OF A POSITIVE WASSERMANN REACTION 167 



more, it disappears at the latest three months after the infection, usually much 

 sooner. As for trypanosomiasis and malaria convincing data are still too few. In 

 malaria the reaction is always negative if the parasites are absent. 



These diseases excluded, a positive Wassermann reaction can be taken 

 as certain proof of the existence of lues. Whether such a test is indicative 

 of a by-gone infection or whether it means that an active process is still 

 going on, has been for a long time a subject of discussion. The author is 

 of the firm opinion that the demonstration of the "lues reagine" means active 

 lues. The reason^ for this belief are as follows : 



1. The almost constant presence of the reaction in all cases of manifest 

 lues excepting primary lesions. During this initial stage it is entirely 

 absent or only faintly positive. It appears, however, later on. 



2. The practically assured existence of the reaction with a recurrence 

 of symptoms even though formerly it was negative. 



3. The possibility of influencing a positive reaction so that it becomes 

 negative, by the use of mercury. The latter holds true also for those cases 

 which show no symptoms and are therefore incorrectly designated as 

 latent syphilis. It has been proven that such are in reality by no means 

 latent, but have an active process at some point escaping detection, as the 

 aorta. Only cases of a nature which have no symptoms and a negative 

 reaction should be considered as latent syphilis; those, however, with no 

 symptoms, but a positive reaction as belonging to the class of active lues. 



4. The evidence that apparently healthy individuals, but with r a 

 positive reaction, have infected others, or have suddenly developed 

 tertiary or postluetic manifestations tabes, paresis, diseases of the 

 aorta, etc. 



An objection has frequently been raised, that in spite of existing disease, the reac- 

 tion has been found negative. If the statistics covering the largest number of cases are 

 studied, it will be seen that such instances are rare. Exceptions are discovered 

 in every biological reaction, especially one which is complicated, and where five different 

 agents come into play; even in the immunization of animals differences will be 

 found in that some produce a highly agglutinating or precipitating, etc., serum, while 

 others will show few or even no antibodies. Individual differences are prevalent to 

 such an extent that exceptions to the rule must be taken for granted. Fortunately, a 

 negative reaction in existing lues is so rare, that for practical purposes its possibility 

 may be overlooked, at least, with reservation. 



As a general rule, antibodies persist in an organism for a certain time after infection, 

 when the individual has become perfectly well. Discussion, to the effect that it may 

 be possible for a positive Wassermann reaction to similarly signify a past infection or a 

 state of immunity, has been raised. But it must be said that immunity in syphilis 

 is a condition thus far unproven, and almost unknown. All symptoms previously 

 attributed to such an immunity can more easily be explained in the light of a continua- 

 tion of the disease. As for the "lues reagine" remaining after the cure of the infec- 

 tion, this phenomenon is undoubtedly possible. The analogy with other diseases seems 

 lost, however, when one considers that the syphilitic reaction is discovered thirty or 



