MODIFICATIONS OF THE WASSERMANN REACTION 463 



reaction may constitute the only evidence of the existence of the disease, 

 and prompt institution of treatment may prevent the development of 

 tertiary lesions, which are so likely to follow. When the spirochetes 

 are few in number and are dormant, there is little tissue destruction or 

 alteration, and, as a result, so little reagin is frequently present in the 

 body-fluids that the Wassermann reaction will fail to detect the disease. 



(a) In 363 cases of early latent syphilis, or those included within a 

 period of three years after infection, Boas found positive reactions in 

 about 40 per cent. ; in latent cases of long standing, or in those following 

 manifest tertiary lesions, the same investigator found 22 per cent, of 

 positive reactions among those who had received proper treatment; of 

 those receiving indifferent treatment, 74 per cent, reacted positively, 

 giving a general average of about 48 per cent. 



(6) The reaction with cerebrospinal fluid depends upon whether or 

 not the central nervous system is involved in the syphilitic process. Of 

 104 latent cases of syphilis in whom the spinal fluid was examined by 

 Altman and Dreyfus, positive reactions were found in about 10 per cent. 



5. Congenital Syphilis. The Wassermann reaction has thrown 

 considerable light upon the subject of congenital syphilis. While, in 

 general, the majority of cases react positively, the results are largely 

 dependent upon the time when the examinations are made, a fact brought 

 out by the highly instructive and systematic investigations of Boas and 

 Thomsen. These investigators divided their cases into three groups: 

 (1) Newly born children and their mothers; (2) two-year-old children; 

 (3) older children with congenital syphilis. 



(a) Of 88 children born of syphilitic mothers and examined at birth, 

 the reaction was positive in 31 and negative in 57 cases. Of the 31 

 positive cases, 4 showed no symptoms of syphilis for a period of observa- 

 tion covering from three to nine months, and it is possible that the 

 syphilis reagin, and not the spirochetes, from the blood of the mother, 

 passed into the circulation of the child; on the other hand, all four cases 

 may have been examples of retarded congenital syphilis. The remaining 

 27 cases either developed symptoms of syphilis or died later with syphil- 

 itic manifestations in various organs. 



Of the 57 children reacting negatively at birth, 42 showed no symp- 

 toms of syphilis during a period of three months of observation; 2 died 

 with evidences of syphilis in the internal organs; 13 developed symptoms 

 after birth and gave positive reactions. 



It may therefore be stated that a Wassermann reaction of the mother 

 and of the child at the time of birth in cases where syphilis of the mother 



