MODIFICATIONS OF THE WASSERMANN REACTION 461 



is so well demonstrated. The initial lesion may have been inconspicuous 

 and hence have been overlooked, and the secondary lesions may be 

 quite mild and inconclusive; in either case the Wassermann reaction 

 will usually establish the diagnosis. 



(a) In untreated secondary syphilis the reaction is positive in from 

 92 to 100 per cent, of cases. In the examination of 437 serums from 

 untreated cases Boas has never had a negative reaction, and my own 

 experience has been the same. 



(6) With the serums of patients who have received some treatment, 

 the percentage of positive reactions will be slightly lower. Of 310 such 

 cases examined by Boas, 97.6 reacted positively. The influence of 

 treatment upon the reaction is to be remembered, and a single negative 

 reaction does not by any means exclude the possibility of syphilis. 



(c) The intensity of the reaction does not bear any direct relation 

 to the severity of the infection: a mild infection with indefinite signs 

 may react quite strongly and absorb a large number of units of comple- 

 ment, whereas a severe case may react quite mildly. 



(d) In secondary syphilis without cerebral symptoms the cerebro- 

 spinal fluid is practically always negative (Plaut, Boas and Lind); 

 conversely, cases showing cerebral involvement usually react positively. 

 More recent work has shown that the cerebrospinal system is involved 

 early and in a relatively large number of cases (Craig and Collins 1 ). 

 Udo J. Wile has found that about 30 per cent, of secondary syphilitics 

 give a positive reaction with cerebrospinal fluid. 



3. In Tertiary Syphilis. It is probably in tertiary syphilis that the 

 Wassermann reaction has its greatest value. Lues is so diverse in 

 character, and may be responsible for so many diverse clinical conditions, 

 that the reaction has become well-nigh indispensable as a diagnostic 

 aid. There is no limit to the time following infection in which positive 

 reactions may not be found. 



(a) In cases of untreated and active tertiary syphilis the reaction is 

 positive in about 96 per cent, of cases. 



(6) In cases receiving more or less antispecific treatment the reac- 

 tions are positive in about 75 per cent. In general, therefore, a positive 

 reaction in tertiary syphilis may be expected in from 80 to 85 per cent, 

 of cases. 



(c) In a large percentage of cases of syphilitic aortitis, aortic aneu- 

 rysm, aortic insufficiency, gummas of various organs, etc., the reaction 

 is positive and possesses great diagnostic value. 



1 Jour. Amer. Med. Assoc., 1914, Ixii, 1955. 



