520 TREPONEMATA AND SPIROCHETA 



For a time the specificity of the Wassermann reaction for syphilis 

 was questioned, because it was found that alcoholic extracts of normal 

 heart could be substituted for extracts of luetic organs as antigens. 

 A careful study of thousands of cases has shown, however, that a vast 

 majority of active syphilitic infections, especially those in the second- 

 ary stage, give a positive Wassermann reaction. During the earlier 

 part of the primary stage the reaction is frequently negative. In 

 the tertiary stage the reaction is frequently positive and the spinal 

 fluid frequently gives a positive reaction as well. Occasionally cases 

 of frambesia and of leprosy give a positive Wassermann reaction, 

 but these diseases are rare in temperate climates. For a time it was 

 believed that the serum in cases of scarlet fever gave a Wassermann 

 reaction, but this view has not been fully substantiated. 



Statistics indicate that the Wassermann reaction disappears when 

 a cure "is effected, but it reappears if the disease again becomes active. 

 It is important to remember that the mercurial treatment tends to 

 diminish the intensity of the reaction, and it may even disappear 

 temporarily. Treatment with salvarsan and neosalvarsan may accen- 

 tuate the reaction, temporarily at least. 



There is no doubt that the Wassermann reaction carefully executed 

 by competent workers is the most delicate and reliable diagnostic 

 method for syphilis known at the present time. 



4. Luetin reaction. 1 



Preparation of Luetin. A culture of Treponema pallidum is ground 

 until the organisms are thoroughly disrupted, then heated to 60 C. 

 for an hour and suspended in sterile salt solution to which is added 

 0.5 per cent, carbolic acid as a preservative. The reaction induced 

 in syphilitics is essentially like the tuberculin reaction. It consists 

 in the development of a vesicle or a pustule at the site of inoculation 

 with temperature and pain. The control inoculation should exhibit 

 but a slight reddening. The reaction is specific, except for old, 

 advanced cases, where the reaction may fail. It is most marked in 

 the later tertiary and congenital cases where the Wassermann reac- 

 tion is said to be more likely to be negative. 



Clinical Methods of Serum Diagnosis. Method of Forges and Meyer. 

 The principle of this reaction depends on the production of a precipi- 

 tate when syphilitic serum is mixed with lecithin. Normal serum does 

 not produce a precipitate under these conditions. The technic con- 

 sists in thoroughly triturating 0.25 grams of lecithin (ovolecithin) in 



1 Noguchi, Jour. Exp. Med., 1911, xiii, 557. 



