230 The Philippine Journal of Science 1923 



of syphilis, and has been frequently reported in malaria, but its 

 constancy in yaws is very confusing from the standpoint of dif- 

 ferential diagnosis. In a district infested with yaws the reaction 

 is of no value in diagnosing syphilis. However, the treatment 

 of the two diseases being the same, the reaction is of great value 

 from the standpoint of indicating the need of salvarsan therapy. 

 While a positive test in yaws, as in syphilis, presupposes infec- 

 tion, a different estimate must be placed on the behavior of the 

 reaction following treatment with neosalvarsan. This is due 

 largely to the fact that yaws is ordinarily much more amenable 

 to treatment and a few injections not infrequently effect a com- 

 plete cure, although the Wassermann reaction may remain 

 positive for several months afterward, gradually becoming 

 weaker, however, and eventually negative, without further in- 

 jection of neosalvarsan. It is unnecessary therefore to continue 

 treatment until a negative reaction is obtained. In syphilis, 

 on the other hand, the test often becomes negative under inten- 

 sive treatment only to become positive again when injections 

 are discontinued. Neither yaws nor syphilis can be regarded as 

 completely cured so long as a positive test persists, but in yaws 

 a cure may be presumed on the disappearance of clinical evi- 

 dence of activity, and no further treatment is necessary unless 

 the reaction persists or becomes stronger after the lapse of 

 many months. 



Although in the case reported by Shamberg and Klauder the 

 Wassermann reaction became negative with alcoholic extract of 

 syphilitic liver and acetone insoluble antigen and 1 + as re- 

 corded in their chart, and 2 + as stated in the text, in a scheme 

 in which 4 -+- indicated complete fixation, the authors never- 

 theless considered the infection still present. Evidently they 

 were applying to yaws the same significance which experience 

 has taught attaches to a persistence of a positive reaction in 

 syphilis. Interpreted in the light of our results, one is justified 

 in assuming that their case was cured and that in a few months 

 the reaction would have become negative spontaneously. 



In the absence of clinical manifestation of activity a negative 

 Wassermann test must be the final criterion of a cure in yaws. 

 Consequently, the reaction should be used to establish the efficacy 

 of any treatment of yaws such as with tartar emetic as used by 

 Castellani ; and in latent yaws, where clinical evidences are slight, 

 it should be of utmost importance in determining the effect of 

 treatment with neosalvarsan or other methods. 



