THE LUETIN REACTION 319 



secondary syphilis under regular mercurial treatment in whom there 

 are no manifest lesions at the time of making the skin test. Patients 

 with congenital syphilis also show this reaction in the early period of 

 life." In the second pustular form "the beginning and course of the 

 reaction resemble the papular form until about the fourth day, 

 when the inflammatory processes commence to progress. The 

 surface of the indurated, round papule becomes mildly edematous, 

 and multiple miliary vesicles occasionally form. At the same time 

 a beginning central softening of the papule can be seen. Within 

 the next twenty-four hours the papule changes into a vesicle, filled 

 at first with a semi-opaque serum that later becomes definitely 

 purulent. Soon after this the pustule ruptures spontaneously or 

 after slight friction or pressure. The margin of the broken pustule 

 remains indurated, while the defect caused by the escape of the 

 pustular contents becomes quickly covered by a crust that falls off 

 within a few days. About this time the induration usually disappears, 

 leaving almost no scar after healing. There is a wide range of 

 variation in the degree of intensity of the reaction described in 

 different cases, as some show rather small pustules, while in others 

 the pustule is much larger. This reaction was found almost constant 

 in patients with tertiary or late hereditary syphilis" (see Plate X). 



In the third or torpid form, which was only noted in rare instances, 

 "the injection sites fade away to almost invisible points within 

 three or four days, so that they may be passed over as negative 

 reactions. But sometimes these spots suddenly light up again after 

 ten days, or even longer, and progress to small pustular formation. 

 The course of this pustule is similar to that described for the preceding 

 form. 



"This form of reaction has been observed in a case of primary 

 syphilis, in one of hereditary syphilis, and in two cases of secondary 

 syphilis, all being under mercurial treatment. 



"If no change occurs after four or five days the reaction should 

 accordingly not be termed negative and Noguchi advises that the 

 observation of the patient be continued for at least three or four 

 weeks. 



"Neither in syphilitics nor in parasyphilitics did a marked consti- 

 tutional effect follow the intradermic inoculation of the luetin. In 

 most positive cases a slight rise in temperature took place, lasting 



