LUES ASYMPTOMATICA 1 69 



schematic, symptomatic, chronic, intermittent treatment of Fournier and 

 Neisser. 



At the present day, when the spirochaetes can be so readily found in the 

 primary lesion of syphilis, the biological mercurial treatment should be 

 undertaken in the earliest stage. It is possible even to begin at a time 

 when the serum reaction is still negative, but after the spirochaetes have 

 been demonstrated. The most ideal cases are those in which treatment is 

 instituted so early that they never develop a positive Wassermann test. 



Naturally the statement made that mercurial treatment should be continued until 

 the reaction becomes negative may be limited by certain centra-indications which may 

 arise in the general condition of the patient. This must always be considered. Especial 

 difficulty to attain a negative reaction is encountered in those cases in which lues has 

 persisted for many years. 



It must be kept in mind that the luetic infection does not always present 

 the typical clinical picture ascribed to it in the text-books. The "Lues 

 asymptomatica," that is, the lues apparently presenting no symptoms, is 

 by no means rare. To-day one must not wait until the syphilitic patient 

 comes to the physician, but it is the duty of the latter to look for the evidence of 

 syphilis among those related to or associated with infected persons. If one 

 proceeds in such a systematic method it will be found that the mothers of 

 syphilitic children, so frequently regarded as immune, are in reality not so. 

 In such cases, without any clinical evidence of syphilis, the Wassermann 

 reaction is positive in about 56 to 75 per cent. 



This question becomes of utmost importance in the prevention of lues. 

 For example the obligatory examination of the serum of wet nurses has 

 shown that of all such applicants at the Dresden Infant Asylum 10 per cent, 

 gave a positive reaction (Rietschels) . On further study it was ascertained 

 that 75 per cent, of the children of these apparently healthy women gave 

 luetic manifestations immediately or shortly after birth. 



The Wassermann Test also offers a certain guide as to the prognosis 

 of a case. Thus the outlook is unfavorable if in spite of energetic treat- 

 ment a reaction remains constantly positive. Even with the absence of 

 all external lesions such a condition can be classified as a "lues maligna." 

 As a rule this term is applied to external obvious syphilitic manifestations 

 that remain entirely uninfluenced by mercurial therapy. When it is con- 

 sidered that all general paralysis patients react very strongly positive, the 

 importance of bringing about a negative reaction is sufficiently impressed. 

 Salvarsan is of great help toward this aim. 



A rapid disappearance of a positive Wassermann reaction after specific 

 therapy offers a good prognosis. This is the more favorable the longer 

 the negative test persists. Its continuation over several years with no 

 clinical manifestations can be accepted as a cure of the syphilitic infection. 



