153 



He examined eighty-two patients with secondary syphilis before and after mercurial 

 therapy. All gave positive reactions before the treatment; after it, seventy-six gave no 

 reaction, six retained the positive reactions; one of the six did not return for observation. 

 Of the remaining five, all had a return of symptoms within one month after cessation of 

 the mercury, while of the seventy-six only three returned with a recurrence. Boas next 

 made observations of sixty-five patients who were in the first three years of their infection, 

 but who gave a negative Wassermann after the treatment. In sixty-two cases, a positive 

 reaction reappeared after one to two months, eight of these having at the same time a 

 recurrence of symptoms; of the remaining fifty-four, nineteen were not treated. They 

 all showed a return of symptoms, but only one and a half months after the appearance 

 of the positive Wassermann. Thus if the scheme of the chronic intermittent mercurial 

 therapy of Neisser and Fournier were followed, these patients would begin to get treatment 

 one and a half months after the active lues had again started, as shown by the positive 

 Wassermann reaction. Of the remaining thirty-five cases all began treatment when the 

 Wassermann test became positive. None of these had any return of symptoms during the 

 following period of observation (three to five months). 



The experiments of Boas show distinctly the advantages of the mercurial 

 therapy when based upon the biological reaction instead of upon the sche- 

 matic, 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 spirochaete had been 

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

 instituted so early that they never develop a positive Wassermann. 



Naturally the statement made that mercurial treatment should be continued until 

 the reaction becomes negative may be limited by certain contra-indications in the general 

 condition of the patient which may arise. This must always be considered. Especial 

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

 persisted for many years. 



It must be borne 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 



