492 THE TECHNIC OF COMPLEMENT-FIXATION REACTIONS 



THE EFFECT OF TREATMENT UPON THE WASSERMANN REACTION 

 Citron originally observed that during the mercurial treatment of 

 syphilis the Wassermann reaction gradually became weaker, and finally 

 disappeared. He also found that treatment was best governed by the 

 serum reaction, and that it should be persisted in until a negative re- 

 action was secured. His observations have in the main been abundantly 

 confirmed by various observers the world over, although the extensive 

 series of observations now on record have given us a fuller understanding 

 of its principles. 



The Wassermann reaction is the most constant and delicate single 

 symptom of syphilis, and whenever a serum is found to react positively, 

 antisyphilitic treatment is indicated, and should be persisted in until 

 the reaction becomes negative and remains so for a sufficiently pro- 

 longed period of observation. It is now quite generally believed that 

 a persistently positive reaction indicates the presence of living spiro- 

 chetes, and that treatment should be continued until the blood reacts 

 negatively. The reports of observers from all parts of the world indi- 

 cate quite clearly and conclusively that the schematic, symptomatic, 

 intermittent, and hard and fast rules of treatment of former days are 

 not sufficient. They would also tend to show that the Wassermann 

 reaction is the most delicate symptom and the last to disappear, and 

 that treatment should be continued until this reaction disappears 

 entirely and permanently. It has been abundantly proved, however, that 

 in syphilis a single negative reaction is not sufficient or definite evidence 

 that a cure has been effected, for the disease may recur after treatment is 

 discontinued, at least to the extent that the Wassermann reaction reappears, 

 followed by clinical manifestations. It is necessary, therefore, that sue- 

 cessive examinations be made during a period of at least two years, and off 

 and on during the remainder of life. Recent work indicates that certain 

 strains of Spirochseta pallida have an apparent selective affinity for the 

 tissues of the central nervous system; the Wassermann reaction with 

 blood-serum may be negative, whereas with the cerebrospinal fluid it 

 may be positive. In cases, therefore, of tertiary syphilis, at least, it is 

 advisable to examine the spinal fluid and continue treatment in case it 

 shows a positive Wassermann reaction. 



It should be the object of treatment, in every case, not only to dis- 

 sipate the external and obvious lesions of the disease, but to produce a 

 condition of the blood in which the Wassermann reaction is permanently 

 negative. It is quite generally agreed that the older methods of treat- 

 ment, consisting of the administration of mercury and the iodids over 

 fixed and arbitrary periods of time, or until all manifest symptoms have 



