130 CLINICAL BACTERIOLOGY AND H^EMATOLOGY 



tive reaction. A patient who has a doubtful rash, and who 

 does not give a Wassermann reaction, is almost certainly not 

 syphilitic. 



3. At the outset of the tertiary stage practically every 

 patient gives the reaction, and, if the disease remains active, 

 continues to do so. If the disease becomes latent, the reaction 

 usually becomes very weak, or may disappear altogether; but 

 recurs should symptoms recur. In the very late stage of the 

 disease, however, twenty years or so after infection, a definite 

 gumma or syphilitic ulcer may occur with a negative reaction. 

 This is unusual, and I have seen a positive reaction in a man 

 forty-two years after the sore. 



4. In the "parasyphilitic" affections the reaction may, or 

 may not, be present. In g-eneral paralysis it is almost always 

 present; in tabes in about 60 to 70 per cent, of cases. The 

 accepted and, as I believe, the correct teaching is that, in the 

 latter disease at least, cases which give a positive reaction 

 should have immediate and energetic syphilitic treatment, 

 which offers a fair prospect of arresting the malady. 



In general paralysis the reaction is almost always present 

 in the cerebro-spinal fluid; in tabes it is frequently so. 



5. In congenital cases the reaction is usually present, and 

 indeed very strong, even in quiescent intervals, when there is 

 no sign of disease. It is very difficult to eradicate it by treat- 

 ment indeed, some say impossible, though I have seen cases 

 to the contrary. Apart from this, it usually dies away gradu- 

 ally about the age of puberty, though it may persist well past 

 middle life. This possibility must be borne well in mind when 

 an unexpected positive reaction is met with, and a careful 

 search made for the stigmata of the congenital disease. 



The mothers of children with congenital syphilis usually 

 give a positive reaction. The accepted interpretation of 

 Colles's law is that the mother is actually infected, though in 

 a mild and unobtrusive way. 



6. The effect of mercury is most important to understand. 

 It removes the reaction before the disease is cured. In other 

 words, if the action be watched in a patient under efficient 

 mercurial treatment, it will be found to get weaker, and ulti- 

 mately to disappear. If the drug be now stopped, the 

 reaction will soon reappear, and will gradually become as 

 strong as before. To eradicate the reaction, and, as we 



