MODIFICATIONS OF THE WASSERMANN REACTION 489 



(6) The reaction with cerebrospinal fluid depends upon whether or 

 not the central nervous system is involved in the syphilitic process. Of 

 104 latent cases of syphilis in whom the spinal fluid was examined by 

 Altman and Dreyfus, positive reactions were found in about 10 per cent. 



5. Congenital Syphilis. The Wassermann reaction has thrown 

 considerable light upon the subject of congenital syphilis. While, in 

 general, the majority of cases react positively, the results are largely 

 dependent upon the time when the examinations are made, a fact brought 

 out by the highly instructive and systematic investigations of Boas and 

 Thomsen. These investigators divided their cases into three groups: 

 (1) Newly born children and their mothers; (2) two-year-old children; 

 (3) older children with congenital syphilis. 



(a) Of 88 children born of syphilitic mothers and examined at birth, 

 the reaction was positive in 31 and negative in 57 cases. Of the 31 

 positive cases, 4 showed no symptoms of syphilis for a period of observa- 

 tion covering from three to nine months, and it is possible that the 

 syphilis reagin, and not the spirochetes, from the blood of the mother, 

 passed into the circulation of the child; on the other hand, all four cases 

 may have been examples of retarded congenital syphilis. The remaining 

 27 cases either developed symptoms of syphilis or died later with syphil- 

 itic manifestations in various organs. 



Of the 57 children reacting negatively at birth, 42 showed no symp- 

 toms of syphilis during a period of three months of observation; 2 died 

 with evidences of syphilis in the internal organs; 13 developed symptoms 

 after birth and gave positive reactions. 



It may therefore be stated that a Wassermann reaction of the mother 

 and of the child at the time of birth in cases where syphilis of the mother 

 is suspected has considerable prognostic value. A large majority of 

 children reacting positively develop symptoms of syphilis; on the other 

 hand, the majority reacting negatively remain healthy. While an 

 examination of the mother alone does not warrant an absolutely definite 

 prognosis for the child, in general it may be said that a positive reaction 

 does not constitute a favorable prognostic sign for the child. 



(6) The Wassermann reaction has also shed new light upon the 

 interpretation of Colles' law. Since the "apparently healthy mother 

 of a syphilitic child could suckle the child without being infected, whereas 

 the child is capable of giving syphilis to others/' the most logical con- 

 clusion to draw is that the mother was gradually immunized against 

 syphilis during pregnancy, whereas we now know that the majority of 

 mothers show positive serum reactions and are really latent syphilitics; 

 in not a few such instances tertiary lesions have developed at a later date. 



