494 THE TECHNIC OF COMPLEMENT-FIXATION REACTIONS 



greater the interval of time allowed to elapse between infection and in- 

 stitution of treatment, the more difficult it is to restore the serum to 

 normal. Tertiary cases are cured only as the result of most persistent 

 treatment, and not infrequently in congenital syphilis, locomotor ataxia, 

 and general paralysis all one can hope to accomplish is to check the 

 progress of the disease. The most favorable cases are those in which 

 early diagnosis is made possible by clinical manifestations, preferably 

 confirmed by a demonstration of pallidum, and in which treatment is 

 undertaken before the serum has begun to react positively, and in which the 

 reaction remains negative throughout. 



Treatment will, however, at least influence the Wassermann reaction 

 in practically all stages of syphilis. In a series of 435 cases of syphilis 

 in all stages reported by Boas, a negative Wassermann reaction was 

 secured in no less than 80 per cent., and all but one of the remaining cases 

 showed a weaker reaction. The figures of different observers are not 

 all so favorable as these, a factor dependent to some extent, at least, 

 upon differences in the technic of the reaction. In general, however, 

 Boas' observations have been confirmed by other competent workers. 



The effect of any treatment is greatly influenced by the individuality 

 of the host, certain persons possessing tissues more amenable to the 

 effects of the therapeutic agent than those of others. The therapeutic 

 effect is also dependent upon the virulence of the parasite and the 

 apparent selective affinity of certain strains of pallidum for particular 

 organs, and upon the method of treatment selected. 



The influence of salvarsan and neosalvarsan as agents in the treat- 

 ment of syphilis is considered in more detail in the chapter on Chemo- 

 therapy. My experience has shown that the earlier belief in the com- 

 plete sterilization of the human patient by a single dose was generally 

 unfounded, and that repeated smaller doses of the drug, used in con- 

 junction with mercurials, are necessary. Potassium iodid alone may 

 favorably influence the clinical symptoms and weaken the Wassermann 

 reaction in a small percentage of cases, and the same result has been ob- 

 served with such arsenical preparations as Fowler's solution, atoxyl, 

 arsacetin, and arsenophenylglycin. 



It is to be remembered that, during or immediately after active 

 treatment with salvarsan or mercury, the Wassermann reaction may be 

 negative, even though the patient is not cured. As a general rule, a 

 negative reaction under these conditions should not be considered of 

 value unless all treatment has been omitted for at least two weeks; 

 even then the test, if negative, should be repeated a month or so later. 



