

MODIFICATIONS OF THE WASSERMANN REACTION 467 



followed by clinical manifestations. It is necessary, therefore, that suc- 

 cessive examinations be made during a period of at least two years, and off 

 and on during the remainder of lifej Recent work indicates that certain 

 strains of Spirochseta pallida have an apparent selective affinity for the 

 tissues of the central nervous system; the Wassermann reaction with 

 blood-serum may be negative, whereas with the cerebrospinal fluid it 

 may be positive. In cases, therefore, of tertiary syphilis, at least, it is 

 advisable to examine the spinal fluid and continue treatment in case it 

 shows a positive Wassermann reaction. 



It should be the object of treatment, in every case, not only to dis- 

 sipate the external and obvious lesions of the disease, but to produce a 

 condition of the blood in which the Wassermann reaction is permanently 

 negative. It is quite generally agreed that the older methods of treat- 

 ment, consisting of the administration of mercury and the iodids over 

 fixed and arbitrary periods of time, or until all manifest symptoms have 

 disappeared, are insufficient, and that the criteria by which the effects of 

 treatment can best be judged are: (1) Continued absence of symptoms, 

 and (2) permanent negative Wassermann reactions. 



It is to be remembered, therefore, that while a single negative 

 reaction is a satisfactory indication of the progress of treatment, it does 

 not signify that a permanent cure has been effected. The Wassermann 

 reaction cannot be regarded as sufficiently delicate to indicate that a 

 single negative reaction means that a patient is totally free from all 

 spirochetes, for in some instances the reaction and the clinical symptoms 

 may recur after the treatment has been suspended, but the reaction is 

 the first symptom to reappear and the earliest indication of an impending 

 lesion. For all practical purposes the occurrence of a negative reaction 

 after treatment indicates either complete destruction of all the spiro- 

 chetes, or at least that the parasites are being held in abeyance and 

 rendered potentially harmless. 



It is, accordingly, reasonable to regard the Wassermann reaction as 

 the most delicate indicator of generalized spirochetal infection or the 

 assumption of spirochetal activity. A positive reaction indicates that 

 serious effects and gross local lesions are likely to occur at any time, and 

 that treatment should be continued. For all practical purposes a con 

 tinued absence of symptoms and a permanently negative reaction are 

 strong presumptive evidences that a cure has been effected. 



The serum should be tested every six months during the treatment, 

 and at periods of at least six months to a year after treatment has been 

 discontinued for several years. Persistently positive reactions during 



