348 APPLIED IMMUNOLOGY 



Results of Specific Treatment in Syphilis, — We have four 

 ways of measuring the effect of salvarsan in the treatment of 

 syphilis: (1) the disappearance of treponemata pallida, (2) 

 the disappearance of lesions, (3) the recurrence of lesions and 

 (4) the Wassermann reaction. Of these, the first, constitut- 

 ing the clinical symptomatology, is the most important. How- 

 ever, the value of the Wassermann reaction, correctly and 

 competently performed, in the diagnosis and control of the 

 treatment of syphilis, must not be underestimated, since, by 

 its use, the diagnosis in doubtful cases may be determined 

 and by its periodic utilization, recurrence of lesions may be 

 avoided. 



The earlier and more intensive the antisyphilitic treat- 

 ment, whether by salvarsan or mercury, the sooner and 

 more lasting are negative results to be expected. A single 

 negative result serologically does not signify cure and is 

 commonly observed in the treatment of early syphilis; the 

 Wassermann reaction may rapidly return to positive if the 

 amount of treatment has been insufficient. On the other 

 hand, the duration of negative reactions is directly propor- 

 tional to the thoroughness of treatment. Mcintosh and 

 Fildes state that positive reactions in the secondary stage of 

 syphilis may be expected to become negative after a single 

 course of mercury in 66 per cent, of cases ; in tertiary syph- 

 ilis in 33 per cent, of cases. One-half to two-thirds of patients 

 have negative reactions after ten courses of mercury or two 

 years of pills. It is safe to conclude that one-third to one- 

 half of all patients treated by the old-fashioned method, 

 although exhibiting no signs or symptoms, judged from the 

 serological standpoint are or were not cured of syphilis. May 

 this large percentage not include many of those patients who 

 later in life develop tabes dorsalis and paresis.'' 



What has salvarsan added to the curability of syphilis? 



