MODIFICATIONS OF THE WASSERMANN REACTION 491 



quite confusing and contradictory. Following the original communica- 

 tions of Wassermann and Detre, and especially after it was demonstrated 

 that the antigen need not be biologically specific, the subject was ex- 

 tensively investigated by various observers, who reported securing 

 positive reactions in many different diseases, results that we now know 

 must have been due largely to technical errors. At present it is known 

 that positive Wassermann reactions may occur in a few diseases other 

 than syphilis, but not to the extent that earlier investigators would have 

 us believe. In most of the diseases yielding positive reactions the 

 clinical symptoms are so marked that they may readily be differentiated 

 from syphilis, and accordingly the Wassermann reaction is of unequaled 

 and incalculable diagnostic value. 



Positive reactions have been reported mframbesia (yaws), in which 

 the causal microorganism, the Spirochaeta pertenuis, is morphologically 

 almost indistinguishable from Spirochaeta pallidum. In leprosy of the 

 tuberous type positive reactions are frequently found, but cases of 

 anesthetic leprosy usually react negatively. Positive reactions have 

 been reported in cases of malaria during the febrile stage, when para- 

 sites are present, although the majority of cases react negatively. In 

 my own series of 11 cases all the reactions were negative. Positive 

 reactions have also been found in some cases of relapsing fever. 



In scarlet fever the Wassermann reaction is uniformly negative. 

 Owing to the original communication of Much and Eichelberg, however, 

 in the minds of many this disease is prominently associated with a 

 positive reaction. While it is true that a positive reaction is very rarely 

 found, it is almost impossible entirely to exclude a diagnosis of con- 

 genital lues, at least in some of these cases. In my own series of 250 

 cases examined by the Wassermann and Noguchi methods, with antigens 

 of alcoholic extract of syphilitic liver and acetone-insoluble lipoids, the 

 reactions were positive in 5 cases, or 2 per cent. Similar results have 

 been secured by Boas, Browning and Mackenzie, and others, so that it 

 may be said that the reaction in scarlet fever is uniformly negative. It is 

 also to be remembered that occasionally, or in about 1 to 2 per cent, of 

 cases, a positive reaction may follow ether or chloroform anesthesia, but 

 that this will later disappear. In pellagra Fox, and later Bass, have 

 found occasional positive reactions. Craig and Nickols have reported 

 that blood drawn from Wassermann positive persons immediately after 

 an acute alcoholic debauch may yield a negative result. 



Normal cerebrospinal fluid or the fluid from persons with ordinary 

 non-syphilitic diseases reacts negatively. Positive reactions have been 

 reported in leprosy and in frambesia. 



