MODIFICATIONS OF THE WASSERMANN REACTION 493 



disappeared, are insufficient, and that the criteria by which the effects of 

 treatment can best be judged are: (1) Continued absence of symptoms, 

 and (2) permanent negative Wassermann reactions. 



It is to be remembered, therefore, that while a single negative 

 reaction is a satisfactory indication of the progress of treatment, it does 

 not signify that a permanent cure has been effected. The Wassermann 

 reaction cannot be regarded as sufficiently delicate to indicate that a 

 single negative reaction means that a patient is totally free from all 

 spirochetes, for in some instances the reaction and the clinical symptoms 

 may recur after the treatment has been suspended, but the reaction is 

 the first symptom to reappear and the earliest indication of an impending 

 lesion. For all practical purposes the occurrence of a negative reaction 

 after treatment indicates either complete destruction of all the spiro- 

 chetes, or at least that the parasites are being held in abeyance and 

 rendered potentially harmless. 



It is, accordingly, reasonable to regard the Wassermann reaction as 

 the most delicate indicator of generalized spirochetal infection or the 

 assumption of spirochetal activity. A positive reaction indicates that 

 serious effects and gross local lesions are likely to occur at any time, and 

 that treatment should be continued. For all practical purposes a con- 

 tinued absence of symptoms and a permanently negative reaction are 

 strong presumptive evidences that a cure has been effected. 



The serum should be tested every six months during the treatment, 

 and at periods of at least six months to a year after treatment has been 

 discontinued for several years. Persistently positive reactions during 

 treatment would indicate that more active measures or a change in 

 therapy are needed. The occurrence of a positive reaction after treat- 

 ment has been discontinued is an indication for its resumption. 



For a control on treatment the Wassermann reaction should be made 

 as delicate as possible, for while more prolonged treatment may be some- 

 what irksome to the patient, it is clearly indicated as a preventive of 

 serious after-effects, especially of involvement of the central nervous 

 system. It is in this branch of the work I have found that the use of 

 sensitive cholesterinized extracts as antigens in making the Wassermann 

 reaction or the Noguchi modification with the use of active serum, of 

 great value as the most delicate indicators. 



One fact is to be clearly emphasized, namely, that the earlier energetic 

 treatment is begun, the more likely it is that a permanent cure will be effected. 

 Energetic treatment with mercurials or salvarsan, or, better, with a 

 combination of both, begun early and continued long, will in the majority 

 of cases restore the serum to its normal condition. In general, the 



