MODIFICATIONS OF THE WASSERMANN REACTION 465 



(d) In congenital mental deficiency the Wassermann reaction shows 

 that syphilis plays a larger part in the etiology of this condition than is 

 generally supposed. A not inconsiderable proportion of cases are of 

 infectious origin, and that infection is syphilis. In Little's disease, 

 which is regarded as due to meningeal hemorrhage incidental to injury 

 received during labor, the serum reactions have shown that not in- 

 frequently the hemorrhage has a syphilitic origin. 



THE SPECIFICITY OF THE "WASSERMANN REACTION 



The highly specific nature of the syphilis reaction has been proved 

 by very extensive investigations with the serums of normal persons and 

 of persons afflicted with diseases other than syphilis. Unfortunately, 

 the reaction is beset by so many technical errors that a review of the 

 literature, and especially of the early literature, shows results that are 

 quite confusing and contradictory. Following the original communica- 

 tions of Wassermann and Detre, and especially after it was demonstrated 

 that the antigen need not be biologically specific, the subject was ex- 

 tensively investigated by various observers, who reported securing 

 positive reactions in many different diseases, results that we now know 

 must have been due largely to technical errors. At present it is known 

 that positive Wassermann reactions may occur in a few diseases other 

 than syphilis, but not to the extent that earlier investigators would have 

 us believe. In most of the diseases yielding positive reactions the 

 clinical symptoms are so marked that they may readily be differentiated 

 from syphilis, and accordingly the Wassermann reaction is of unequaled 

 and incalculable diagnostic value. 



Positive reactions have been reported mframbesia (yaws), in which 

 the causal microorganism, the Spirochaeta pertenuis, is morphologically 

 almost indistinguishable from Spirochseta pallidum. In^leprosy of the 

 tuberous type positive reactions are frequently found, but cases of 

 anesthetic leprosy usually react negatively. Positive reactions have 

 been reported in cases of malaria during the febrile stage, when para- 

 sites are present, although the majority of cases react negatively. In 

 my own series of 11 cases all the reactions were negative. Positive 

 reactions have also been found in some cases of relapsing fever. 



In scarlet fever the Wassermann reaction is uniformly negative. 

 Owing to the original communication of Much and Eichelberg, however, 

 in the minds of many this disease is prominently associated with a 

 positive reaction. While it is true that a positive reaction is very rarely 

 found, it is almost impossible entirely to exclude a diagnosis of con- 

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