MODIFICATIONS OF THE WASSERMANN REACTION 469 



The influence of salvarsan and neosalvarsan as agents in the treat- 

 ment of syphilis is considered in more detail in the chapter on Chemo- 

 therapy. My experience has shown that the earlier belief in the com- 

 plete sterilization of the human patient by a single dose was generally 

 unfounded, and that repeated smaller doses of the drug, used in con- 

 junction with mercurials, are necessary. Potassium iodid alone may 

 favorably influence the clinical symptoms and weaken the Wassermann 

 reaction in a small percentage of cases, and the same result has been ob- 

 served with such arsenical preparations as Fowler's solution, atoxyl, 

 arsacetin, and arsenophenylglycin. 



It is to be remembered that, during or immediately after active 

 treatment with salvarsan or mercury, the Wassermann reaction may be 

 negative, even though the patient is not cured. As a general rule, a 

 negative reaction under these conditions should not be considered of 

 value unless all treatment has been omitted for at least two weeks; 

 even then the test, if negative, should be repeated a month or so later. 

 Craig has recently drawn attention to the fact that in frank untreated 

 cases the degree of the reaction may vary within wide limits, and this is 

 especially true if the patients are receiving active treatment. 



Provocatory Stimulation. Paradoxic as it would at first appear, 

 antisyphilitic treatment may convert a negatively reacting serum into 

 a positive one. In not a few cases of latent syphilis reacting negatively 

 the administration of a specific spirillicidal agent, such as mercury or 

 salvarsan, is followed by positive reactions, due probably to the libera- 

 tion of endotoxins from destroyed spirochetes or to a stimulation of the 

 spirochetes by a dose of drug that did not suffice to kill them. This 

 condition is analogous to the Herxheimer reaction, or the aggravation 

 of skin lesions sometimes observed to follow the administration of 

 mercury or salvarsan. The fact possesses practical value, for in cases 

 where lues is known to have been present or is strongly suspected, and 

 the Wassermann reaction is indefinite or negative, the administration of 

 salvarsan or mercury, either internally or by inunction for a period of 

 from ten days to two weeks, followed a week after the last dose by a 

 Wassermann reaction, may now show a positive reaction and thus in- 

 dicate a latent syphilis requiring further treatment. 



PRACTICAL VALUE OF THE WASSERMANN REACTION 



As previously stated, the Wassermann reaction serves two important 

 purposes: (1) As an invaluable aid in the diagnosis and (2) as a guide 

 in the treatment of syphilis. 



