460 THE TECHNIC OF COMPLEMENT-FIXATION REACTIONS 



syphilis are dependent upon the virulence of the infection, the time at 

 which the reaction is made, and the delicacy of the technic, it is not 

 surprising that the results of different investigators vary in the propor- 

 tion of positive reactions obtained. While positive reactions have been 

 said to have been secured before the appearance of the initial lesion, 

 these are rare, and there is always the likelihood that an earlier infection 

 was overlooked. A careful review of our own work and the literature 

 upon this subject establishes the following: 



(a) > A positive reaction may be secured as early as from four to five 

 weeks after infection has occurred.! In such cases, however, it is often- 

 times probable that the time of infection in reality antedates the time 

 given by the patient. Craig has reported a positive reaction occurring 

 five days after the appearance of the initial lesion. Levaditi, Laroche 

 and Yamanouchi, and others have recorded many positive reactions 

 occurring in ten days or more after the chancre made its appearance. 



(6) As a general rule, the Wassermann reaction becomes positive 

 during about the seventh to the eighth week after infection, or just a 

 week or two before the onset of the secondary eruption. In other words, 

 the reaction is usually secured first late in the primary stage, and in a 

 large proportion of cases before the secondary symptoms appear. 



(c) In general, in primary syphilis the Wassermann reaction will be 

 positive in about 80 per cent, of cases; where cholesterinized extracts 

 are used as antigens, or with the Noguchi system, using active serum, 

 the reactions are secured earlier and in a larger percentage of cases. 



(d) It is generally agreed that a diagnosis should be made as early as 

 possible, and vigorous treatment instituted. A Wassermann reaction 

 may be performed, and if it shows a positive result, this indicates the 

 presence of syphilis, even if the lesion under suspicion is not specific, the 

 reaction being due to a previdus infection. A negative reaction, how- 

 ever, does not exclude syphilis, and if it is at all possible, a microscopic 

 examination, using the dark-ground illuminator, should be made for 

 the treponema. In primary syphilis a microscopic examination of the 

 secretions of the lesion by a competent person is usually more valuable 

 than the serum test; as a general rule, both examinations should be 

 made, especially with patients in whom the chancre is almost healed or 

 atypical. 



(e) The cerebrospinal fluid of persons in the primary stage of syphilis 

 has always reacted negatively (Boas). 



2. In Secondary Syphilis. It is in untreated cases of secondary 

 syphilis that the remarkable specificity of the Wassermann reaction 



