MODIFICATIONS OF THE WASSERMANN REACTION 497 



may persist in the blood for some time after recovery from typhoid fever 

 and diphtheria has taken place? The sum total of the experience of 

 investigators from all parts of the world would indicate that a persist- 

 ently positive reaction means the presence of living spirochetes some- 

 where in the body. The lesions may not be active; the patient, while 

 clinically healthy, may be infective, and is always subject to possible 

 recurrences of clinical syphilis. 



Although gummas are slightly infectious, it is now known that they 

 contain living spirochetes, and the former view, which regarded them as 

 sequels, rather than as actual active lesions of syphilis, is no longer 

 tenable. 



Just how long the reaction may remain positive after the patient is 

 actually cured and all spirochetes are dead is, of course, difficult to state, 

 but experimental studies on the lower animals has shown that the reagin 

 disappears somewhat quickly under these conditions. 



Although a persistently negative reaction is of good prognostic 

 importance, it is not so conclusive in the information it yields as is a 

 positive reaction. In other words, an occasional active lues may react 

 negatively, and not infrequently active syphilitic lesions are found at 

 autopsy in persons whose blood reacted negatively during life. While 

 it is true that great harm may result from a false positive diagnosis due 

 to faulty technic, yet it must be admitted that the Wassermann reac- 

 tion is not too delicate, and that we are just as prone to err on the side 

 of securing too many negative reactions. Every effort should be made 

 to render the test as delicate as is possible with specificity. 



While the value and dependability of the Wassermann reaction are 

 based upon skilful technic that will eventually limit the performance 

 of the test to specially trained persons in central laboratories, every 

 effort should be made to render accessible to all persons this valuable 

 diagnostic test of a disease that has such great social and economic 

 importance. At present many persons are unable to afford the expense 

 of a number of tests, or even of one test, as required in the modern 

 treatment of this disease. This deficiency should be corrected, and the 

 test made available in all free dispensaries, especially those under the 

 supervision of a Social Service Department. 

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