250 MEDICAL BACTERIOLOGY 



the fifth tube 0.4 cc. of spinal fluid, and the sixth tube 0.5 cc. of spinal fluid. 

 The reason for this variation will be discussed in the following pages. 



THE SIGNIFICANCE OF THE WASSERMANN REACTION 



Probably no test has been subjected to a greater amount of investigation 

 to detect and correct its faults and determine its value and proportionate weight 

 in diagnosis. While there is much about it not understood at present and per- 

 haps more to be learned, certain facts have been clearly established, which show 

 this test to be of inestimable value. 



There are factors, some of which are recognizable and removable, which at 

 times cause the blood serum or spinal fluid of a patient infected with syphilis 

 to give a negative Wassermann reaction. First among these to be considered 

 is the stage of the disease: 



In primary syphilis (from the appearance of the chancre until the appear- 

 ance of the rash) the serum of most syphilitic patients gives a negative reaction 

 in the first week, many give a negative in the second week, some give a negative 

 result in the third, fourth and fifth weeks; nearly all give a positive reaction 

 after this time. 



In early secondary syphilis, when the disease is active, nearly 100 per cent, 

 give a positive reaction; when the disease is latent from 5 to 20 per cent, give a 

 negative reaction. 



In tertiary syphilis, when active, from i to 10 per cent, give a negative reac- 

 tion; when latent, from 20 to 25 per cent, give a negative reaction; when the 

 reaction is negative in latent syphilis provocative treatment will frequently 

 produce a positive reaction. 



When the blood serum gives a negative reaction in late secondary and 

 tertiary syphilis, the spinal fluid frequently gives a positive reaction. 



In a small per cent., probably less than 2, of paresis both the blood serum and 

 spinal fluid give a negative reaction. 



The serum of a syphilitic patient, obtained during or shortly after the patient 

 has been profoundly intoxicated with alcohol, will frequently give a negative 

 reaction. 



When a syphilitic patient has received sufficient mercury or salvarsan to 

 partially or completely subdue signs and symptoms of pathological activity, 

 even though the disease is destined to later manifest its presence, the reaction 

 will frequently be negative for 3 weeks after the treatment has been stopped, 

 occasionally negative for 6 weeks and rarely negative for longer periods, up to a 

 year. 



It is possible that some infections, secondary to syphilis, may cause a tem- 

 porary or permanent suppression of a positive reaction. This has not been dis- 

 covered but is mentioned as a possibility to be considered in certain cases and 

 a lead to desirable research. 



It is impossible to determine yet in what per cent, of dormant congenital 

 syphilis the reaction is negative; the results so far obtained strongly indicate 

 that it is small. 



