296 IMMUNOLOGICAL METHODS OF DIAGNOSIS 



"This form of reaction has been observed in a case of primary 

 syphilis, in one of hereditary syphilis, and in two cases of secondary 

 syphilis, all being under mercurial treatment. 



" Neither in syphilitics nor in parasyphilitics did a marked consti- 

 tutional effect follow the intradermic inoculation of the luetin. In 

 most positive cases a slight rise in temperature took place, lasting 

 for one day. In three tertiary cases and in one hereditary case, how- 

 ever, general malaise, loss of appetite, and diarrhea were noted." 



Results. As regards the specificity and the value of the Noguchi 

 reaction from a diagnostic standpoint there can be but little doubt, 

 and it seems from the data which are thus far available that it is 

 especially serviceable in the late stages of the disease, and in the 

 recognition of congenital cases. 



Noguchi expresses the belief that the allergic condition of the 

 skin persists as long as the infecting agent still survives somewhere 

 in the body, and that its disappearance, cceteris paribus, implies the 

 cure of the patient. It is to be noted, however, that cases occur in 

 which the disease persists in spite of treatment and in spite of the 

 absence of the luetin reaction. 



Kammerer, who has recently repeated Noguchi's work, sums up 

 his experiences as follows: 



The intracutaneous reaction is devoid of danger and entails no 

 special discomfort for the patient. Aside from one uncertain case 

 it was specific for syphilis. A differentiation between the specific 

 and non-specific traumatic reactions is possible in most though 

 not in all cases. In cases of marked reaction the control site 

 also often responds to the point of vesicle or even pustule forma- 

 tion. Of the cases examined which were known to be syphilitic 

 more than half did not give the reaction, the highest percentage 

 of positive findings occurring in late cases. In view of the occurrence 

 of retarded reactions the patients should be observed for two weeks. 

 He further suggests that the addition of 0.5 per cent, carbolic acid 

 may not be sufficient to maintain the sterility of the luetin, a 

 conclusion to which Noguchi himself has also come. How this can 

 best be accomplished remains to be seen. 



As regards the comparative value of the Wassermann and the 

 luetin reaction it is still too early to make any definite statement. 



For the present it will no doubt be advisable to control the one 

 by the other. 



