646 ANAPHYLAXIS IN RELATION TO INFECTION AND IMMUNITY 



positive cases a slight rise in temperature took place, lasting for one day. 

 In three tertiary cases and in one hereditary case, however, general 

 malaise, loss of appetite, and diarrhea were noted." 



As was previously stated, Noguchi now asserts that the control 

 fluid may be omitted. In syphilitic persons this fluid may give a 

 reaction that is less intense and that is not followed by induration, but 

 is due probably to a true allergic condition, whereas in normal persons 

 none or but a slight traumatic reaction occurs. It may at times be 

 difficult, however, to distinguish a slight luetin reaction from a well- 

 marked traumatic reaction, and in these instances an opinion may be 

 withheld until controlled by a second injection in the other arm with 

 control fluid. In other words, while the control fluid need not be used 

 routinely, it is well to have it at hand to be used in these doubtful cases. 



In view of the occasional instances in which the reactions are re- 

 tarded a patient should be observed for two weeks before a reaction is 

 regarded as negative. 



Results. 1. The reports of Noguchi and of a number of different 

 observers show that the luetin reaction is generally negative in the 

 primary and secondary (untreated) stages of syphilis. 



2. In latent and tertiary syphilis Noguchi has reported positive 

 reactions in from 80 to 95 per cent, respectively, and the reports of 

 others have showed from 64 to 100 per cent, of positive reactions. 



3. In cerebrospinal syphilis positive reactions have been reported 

 in from 42 to 80 per cent, of cases. 



4. In congenital syphilis the results have varied within wide limits 

 10 to 96 per cent, of positive reactions. In cases under one year of age 

 Noguchi has reported about 23 per cent., and among later cases 96 

 per cent., of positive reactions. 



5. While a few observers have reported positive results in diseases 

 other than syphilis, it is frequently very difficult absolutely to exclude 

 syphilis, and the general consensus of opinion is unmistakably to the 

 effect that in this country, at least, the luetin reaction is specific for 

 syphilis. Slight reactions may be obtained in frambesia or yaws and 

 leprosy. 



6. Second injections of luetin apparently do not give positive reac- 

 tions in non-syphilitic cases. 



Practical Value. It may be stated in general that the chief value of 

 the luetin reaction is in the diagnosis of those occasional cases of latent, 

 tertiary, or congenital syphilis that fail to react positively with the 

 Wassermann reaction. I am quite convinced that in the majority of 

 cases a negative Wassermann reaction, carefully and skilfully per- 



