470 THE TECHNIC OF COMPLEMENT-FIXATION REACTIONS 



The reaction may be of great value in determining the diagnosis of 

 extragenital sores and of atypical lesions in all stages of syphilis. A 

 negative reaction, however, has less value than a positive one, and 

 whenever possible, a microscopic examination of the secretions with the 

 dark-field illuminator should be made in order to confirm the diagnosis. 

 In early latent syphilis, after the initial lesion has healed, and before 

 the secondary eruption appears, the Wassermann reaction is frequently 

 the only means of making the diagnosis, especially if the chancre has 

 been small, atypical, and practically neglected. 



Indefinite symptoms and clinical unrecognizable cases constitute a 

 considerable proportion of cases of syphilis, and, as is true in all other 

 infections, this class constitutes the greatest menace to public health. 

 Many patients are sincere in denying knowledge of infection and early 

 symptoms may be overlooked, the Wassermann reaction being the sole 

 means of diagnosis and serving in this connection as an invaluable aid. 



Usually the symptoms of syphilis are so well marked in the secondary 

 stage that the reaction is in most instances but confirmatory evidence. 

 However, in doubtful cases a negative reaction excludes syphilis with 

 almost absolute certainty, especially if the reaction is repeatedly 

 negative. 



In the late latent and tertiary stages of syphilis the Wassermann 

 reaction may be the only available basis on which to establish a diagnosis. 

 When one remembers how varied are the clinical manifestations of 

 chronic syphilis, how wide-spread is the disease, and how frequently the 

 reaction establishes the true diagnosis, the reaction must be regarded as 

 being of great value and as an indispensable diagnostic aid. f It must not 

 be forgotten that patients showing an early involvement of the central 

 nervous system, and even those showing no such symptoms, may react 

 negatively with blood-serum and positively with spinal fluid; in all 

 such cases the spinal fluid should be examined whenever possible. ] 



A positive reaction occurring in aborting women is an indication for 

 treatment and may protect the fetus. Similarly a positive reaction in 

 either parent of a seemingly healthy infant is an indication for treatment 

 of the child especially if the mother reacts positively. 



In this connection, however, one point is worthy of special emphasis, 

 namely, that although a positive reaction indicates that the patient is 

 luetic, it does not necessarily mean that a particular lesion is syphilitic. 

 For example, a person may be luetic and yet have a cancerous ulceration 

 of the larynx. The mere fact that the lesion does not improve under 

 antisyphilitic treatment does not detract from the value of the Wasser- 



