MODIFICATIONS OF THE WASSERMANN REACTION 487 



(c) The intensity of the reaction does not bear any direct relation 

 to the severity of the infection: a mild infection with indefinite signs 

 may react quite strongly and absorb a large number of units of comple- 

 ment, whereas a severe case may react quite mildly. 



(d) In secondary syphilis without cerebral symptoms the cerebro-'/ 

 spinal fluid is practically always negative (Plaut, Boas and Lind); 

 conversely, cases showing cerebral involvement usually react positively. 

 More recent work has shown that the cerebrospinal system is involved 

 early and in a relatively large number of cases (Craig and Collins 1 ). 

 Udo J. Wile has found that about 30 per cent, of secondary syphilitics 

 give a positive reaction with cerebrospinal fluid. 



3. In Tertiary Syphilis. It is probably in tertiary syphilis that the / 

 Wassermann reaction has its greatest value. Lues is so diverse in 

 character, and may be responsible for so many diverse clinical conditions, 

 that the reaction has become well-nigh indispensable as a diagnostic 

 aid. There is no limit to the time following infection in which positive 

 reactions may not be found. 



(a) In cases of untreated and active tertiary syphilis the reaction is 

 positive in about 96 per cent, of cases. 



(6) In cases receiving more or less antispecific treatment the reac- 

 tions are positive in about 75 per cent. In general, therefore, a positive 

 reaction in tertiary syphilis may be expected in from 80 to 85 per cent, 

 of cases. 



(c) In a large percentage of cases of syphilitic aortitis, aortic aneu- " 

 rysm, aortic insufficiency, gummas of various organs, etc., the reaction 

 is positive and possesses great diagnostic value. 



(d) The Wassermann reaction has been especially valuable in the 

 study of the so-called parasyphilitic diseases. In general paralysis or 

 paralytic dementia the serum reacts positively in about 100 per cent, of 

 cases, and the cerebrospinal fluid reacts positively in about 92 per cent. 

 The final and conclusive proof of the syphilitic nature of this disease 

 has been furnished by Noguchi and Moore, who found the Treponema 

 pallidum in sections of the brain. In certain cases of general paralysis 

 the blood-serum may react negatively, whereas with the cerebrospinal 

 fluid the reaction is positive. 



The fact that the blood-serum of a patient with a nervous disease 



reacts positively does not necessarily indicate that the nervous disease 



is of syphilitic origin, as the reaction may be due to specific infection of 



some other structure; if, however, the cerebrospinal fluid also reacts 



1 Jour. Amer. Med. Assoc., 1914, Ixii, 1955. 



