468 THE TECHNIC OF COMPLEMENT-FIXATION REACTIONS 



treatment would indicate that more active measures or a change in 

 therapy are needed. The occurrence of a positive reaction after treat- 

 ment has been discontinued is an indication for its resumption. 



For a control on treatment the Wassermann reaction should be made 

 as delicate as possible, for while more prolonged treatment may be some- 

 what irksome to the patient, it is clearly indicated as a preventive of 

 serious after-effects, especially of involvement of the central nervous 

 system. It is in this branch of the work I have found that the use of 

 sensitive cholesterinized extracts as antigens in making the Wassermann 

 reaction or the Noguchi modification with the use of active serum, of 

 great value as the most delicate indicators. 



One fact is to be dearly emphasized, namely, that the earlier energetic 

 treatment is begun, the more likely it is that a permanent cure will be effected. 

 Energetic treatment with mercurials or salvarsan, or, better, with a 

 combination of both, begun early and continued long, will in the majority 

 of cases restore the serum to its normal condition. In general, the 

 greater the interval of time allowed to elapse between infection and in- 

 stitution of treatment, the more difficult it is to restore the serum to 

 normal. Tertiary cases are cured only as the result of most persistent 

 treatment, and not infrequently in congenital syphilis, locomotor ataxia, 

 and general paralysis all .one can hope to accomplish is to check the 

 progress of the disease. The most favorable cases are those in which 

 early diagnosis is made possible by clinical manifestations, preferably 

 confirmed by a demonstration of pallidum, and in which treatment is 

 undertaken before the serum has begun to react positively, and in which the 

 reaction remains negative throughout. 



Treatment will, however, at least influence the Wassermann reaction 

 in practically all stages of syphilis. In a series of 435 cases of syphilis 

 in all stages reported by Boas, a negative Wassermann reaction was 

 secured in no less than 80 per cent., and all but one of the remaining cases 

 showed a weaker reaction. The figures of different observers are not 

 all so favorable as these, a factor dependent to some extent, at least, 

 upon differences in the technic of the reaction. In general, however, 

 Boas' observations have been confirmed by other competent workers. 



The effect of any treatment is greatly influenced by the individuality 

 of the host, certain persons possessing tissues more amenable to the 

 effects of the therapeutic agent than those of others. The therapeutic 

 effect is also dependent upon the virulence of the parasite and the 

 apparent selective affinity of certain strains of pallidum for particular 

 organs, and upon the method of treatment selected. 



