496 THE TECHNIC OF COMPLEMENT-FIXATION REACTIONS 



However, in doubtful cases a negative reaction excludes syphilis with 

 almost absolute certainty, especially if the reaction is repeatedly 

 negative. 



In the late latent and tertiary stages of syphilis the Wassermann 

 reaction may be the only available basis on which to establish a diagnosis. 

 When one remembers how varied are the clinical manifestations of 

 chronic syphilis, how wide-spread is the disease, and how frequently the 

 reaction establishes the true diagnosis, the reaction must be regarded as 

 being of great value and as an indispensable diagnostic aid. It must not 

 be forgotten that patients showing an early involvement of the central 

 nervous system, and even those showing no such symptoms, may react 

 negatively with blood-serum and positively with spinal fluid; in all 

 such cases the spinal fluid should be examined whenever possible. 



A positive reaction occurring in aborting women is an indication for 

 treatment and may protect the fetus. Similarly a positive reaction in 

 either parent of a seemingly healthy infant is an indication for treatment 

 of the child especially if the mother reacts positively. 



In this connection, however, one point is worthy of special emphasis, 

 namely, that although a positive reaction indicates that the patient is 

 luetic, it does not necessarily mean that a particular lesion is syphilitic. 

 For example, a person may be luetic and yet have a cancerous ulceration 

 of the larynx. The mere fact that the lesion does not improve under 

 antisyphilitic treatment does not detract from the value of the Wasser- 

 mann reaction, but is a warning that more care is required in making the 

 clinical examination. I have seen a number of such cases in which a 

 positive Wassermann reaction was held a priori as evidence of the syphil- 

 itic nature of a lesion that later proved to be either malignant or tuber- 

 culous. A weak positive reaction, associated with an active ulcerating 

 lesion, very frequently indicates that the lesion is not syphilitic, for 

 active lesions usually yield strongly positive reactions. 



In this connection may also be mentioned the growing importance 

 the Wassermann reaction has assumed in life-insurance examinations. 

 Statistics show that from one-tenth to one-third of all persons infected 

 with syphilis die as the results of the disease, and the death-rate among 

 5000 syphilitics accepted for insurance was one-third over expectation 

 (Brockbank). 



An important question, especially from the standpoint of thera- 

 peutics is : Does a positive reaction invariably indicate the presence of 

 living spirochetes? May the reaction remain positive for an indefinite 

 time after the patient has been cured, just as agglutinins and antitoxins 



