22.4 Goodpasture: Complement Fixation in Leprosy 429 



negative cases when more than half of similar groups were 

 positive are neglible. It seems evident that with continuous 

 treatment, progressive clinical improvement, and disappearance 

 of acid-fast organisms from accessible parts the substances fix- 

 ing complement with lipoidal antigen are lost gradually. 

 Table 4.— Percentage of positive Wassermann reaction in the three groups. 



Much of the interest in the Wassermann reaction in leprosy 

 has been stimulated by a desire to determine if positive reactions 

 are due to an associated syphilitic infection. As a result 

 numerous observations have been made on the effect of salvarsan 

 on the positive reactions of lepers. Rocamora(8) observed no 

 change in the reaction under prolonged treatment; a similar 

 result was noted by Veillon and Lagane;(9) while Jeanselme 

 and Vernes(5) state that a positive reaction continuing during 

 treatment with salvarsan is useful in distinguishing between 

 leprosy and syphilis. 



Five cases of leprosy from the untreated group, three of 

 whom had a strongly positive reaction and two a weakly positive, 

 received injections of mercury for six weeks, and at the end of 

 this period there was no change in the strength of the reaction 

 in any of them. 



The presence of a positive Wassermann reaction in leprosy 

 in the majority of cases must be assumed to be a result of infec- 

 tion with Bacillus leprse; the disappearance of positive Was- 

 sermann reaction appears to be a specific phenomenon associated 

 with improvement in clinical signs and diminution in number 

 of the acid-fast bacilli, the reaction not yielding to syphilitic 

 therapy. 



There are several considerations, however, which eliminate 

 the Wassermann reaction from useful application as a measure 

 of the effect of treatment in leprosy. The first of these is the 

 small proportion of untreated cases which give a positive re- 

 action, and the large proportion of weak fixations among those 

 that do; for one of the most essential features of a successful 

 test of this sort is that it be positive in practically 100 per cent 



