210 INFECTION AND RESISTANCE 



Jacobaeus 32 and of Wechselman. 33 It seems, however, that, as the 

 reaction is gaining in importance in clinical diagnosis, most labora- 

 tories are adhering to the original system used by Wassermann and 

 his associates, except for the substitution of the non-specific lipoidal 

 antigens for the originally employed organ extracts. 



The value of the Wassermann test in the diagnosis of the various 

 stages of syphilis is a problem which can be approached only by 

 careful statistical analysis of the results obtained. This has been 

 done by various investigators, and some of the results have been 

 tabulated in the books of Noguchi, of Boas, and of Mclntosh and 

 Fildes. The figures we cite are those largely taken from Boas, as 

 summarized in F. C. Wood's "Chemical and Microscopical Diag- 

 nosis" (D. Appleton & Co., 1911), pp. 706 et seq. 



Primary syphilis, 974 cases, 56.5 per cent, positive. 



The reaction may appear before the primary sore, but this is 

 very rare. Usually it is positive in from 5 to 6 weeks after infection. 

 Secondary syphilis, 2,762 cases, 88 per cent, positive. In untreated 



cases they are stated to be 100 per cent, positive. 

 Tertiary syphilis, 830 cases, 80 per cent, positive. 

 Tabes, 360 cases, 70 per cent, positive. 

 Dementia paralytica, 95 to 100 per cent, positive. 



The tabulation on the following page, taken directly from Boas, 

 will give a comprehensive summary of this phase of the problem. 



Since the reaction is not a specific antigen-antibody union but 

 depends on some substance liberated or produced by reason of the 

 syphilitic injection, it is not out of question that other infections 

 may give rise to a "positive Wassermann." And this, indeed, is 

 the case. It was claimed for a time that a positive reaction may 

 be obtained in tuberculosis, but this has been refuted by subsequent 

 experience, and the earlier positive results probably depended upon 

 faulty technique. There can be little doubt, however, that occasional 

 positive reactions are obtained in cases of leprosy, scarlet fever, 

 malaria, and trypanosoma infections. 



The spinal fluid may be used instead of the blood serum in cases 

 of syphilis of the central nervous system, but even here, as Citron 34 

 has shown, the results with blood serum are more frequently positive 

 than those done with the spinal fluid itself. In isolated cases posi- 

 tive reactions have been obtained with ascitic fluids, pleural and 

 pericardial exudates. Bab 35 reports a case of positive reaction in 



32 Jacobaeus. Zeitschr. f. Imm., Vol. 8, 1911. 



33 Wechselmann. Zeitschr. f. Imm., Vol. 3, 1909. 



34 Citron. Deut. med. Woch., 1907, No. 29, p. 1165. 

 85 Bab. Munch, med. WocJi., Vol. 46, 1907. 



