SYPHILIS 13! 



believe, to cure the disease, it is necessary to keep on for a 

 long time with mercury, whilst the reaction remains absent. 

 How long, it is impossible to say; probably two years is about 

 the minimum. Hence the Wassermann reaction supplies 

 information of great value in the mercurial treatment. 



(a) If the reaction does not disappear under mercury, the 

 drug is unsuitable to the case, or is not given in sufficient 

 amount, or not in a suitable form. The dose or the method 

 of administration should be changed, or "606" given. 



(b) When the patient has had a negative reaction for what 

 is considered to be a sufficient time, the drug* should be stopped 

 for at least three months, and the blood tested again. If 

 the reaction has returned, the treatment must be resumed. 

 If it is still negative, it should be tested after nine months 

 more, and if still negative, I believe it is safe to say that the 

 disease is cured. 



7. After "606" (salvarsan), as a rule the reaction begins 

 to get weaker from the first. Occasionally, however, it 

 becomes much stronger; an increased reaction is not neces- 

 sarily a bad sign after an injection. 



8. It is now the accepted teaching that a patient who shows 

 a persistent negative reaction is cured and is reinoculable. 

 There is now supposed to be no immunity subsequent to an 

 attack of syphilis; a person either has the disease, or is sus- 

 ceptible to it. But the rule that a persistent negative reaction 

 necessarily indicates complete cure must be qualified a little. 

 It is, I believe, quite true of early cases, but in late tertiaries 

 it is undoubted that the reaction may disappear during a 

 latent period and recur subsequently, or that syphilitic mani- 

 festations may occur (and be cured by mercury or "606") 

 with a negative reaction in very old cases. In most cases, 

 however, the rule is true, and when a patient, not under the 

 influence of mercury, shows a negative reaction on two occa- 

 sions at intervals of six months, I believe we are justified in 

 regarding him as cured. 



9. Do not fall into the mistake of thinking that because a 

 patient gives a positive Wassermann reaction he may not 

 have some disease other than syphilis in addition. A history 

 of syphilis is very common in cases of cancer of the tongue, 

 and a positive Wassermann reaction hardly tells against such 

 a diagnosis. 



