MODIFICATIONS OF THE WASSERMANN REACTION 495 



Craig has recently drawn attention to the fact that in frank untreated 

 cases the degree of the reaction may vary within wide limits, and this is 

 especially true if the patients are receiving active treatment. 



Provocatory Stimulation. Paradoxic as it would at first appear, 

 antisyphilitic treatment may convert a negatively reacting serum into 

 a positive one. In not a few cases of latent syphilis reacting negatively 

 the administration of a specific spirillicidal agent, such as mercury or 

 salvarsan, is followed by positive reactions, due probably to the libera- 

 tion of endotoxins from destroyed spirochetes or to a stimulation of the 

 spirochetes by a dose of drug that did not suffice to kill them. This 

 condition is analogous to the Herxheimer reaction, or the aggravation 

 of skin lesions sometimes observed to follow the administration of 

 mercury or salvarsan. The fact possesses practical value, for in cases 

 where lues is known to have been present or is strongly suspected, and 

 the Wassermann reaction is indefinite or negative, the administration of 

 0.3 to 0.4 gram of salvarsan or neosalvarsan, followed by a Wassermann 

 reaction three days later, may now show a positive reaction and thus 

 indicate a latent syphilis requiring further treatment. 



PRACTICAL VALUE OF THE WASSERMANN REACTION 



As previously stated, the Wassermann reaction serves two important 

 purposes: (1) As an invaluable aid in the diagnosis and (2) as a guide 

 in the treatment of syphilis. 



The reaction may be of great value in determining the diagnosis of 

 extragenital sores and of atypical lesions in all stages of syphilis. A 

 negative reaction, however, has less value than a positive one, and 

 whenever possible, a microscopic examination of the secretions with the 

 dark-field illuminator should be made in order to confirm the diagnosis. 

 In early latent syphilis, after the initial lesion has healed, and before 

 the secondary eruption appears, the Wassermann reaction is frequently 

 the only means of making the diagnosis, especially if the chancre has 

 been small, atypical, and practically neglected. 



Indefinite symptoms and clinical unrecognizable cases constitute a 

 considerable proportion of cases of syphilis, and, as is true in all other 

 infections, this class constitutes the greatest menace to public health. 

 Many patients are sincere in denying knowledge of infection and early 

 symptoms may be overlooked, the Wassermann reaction being the sole 

 means of diagnosis and serving in this connection as an invaluable aid. 



Usually the symptoms of syphilis are so well marked in the secondary 

 stage that the reaction is in most instances but confirmatory evidence. 



