338 BLOOMBERGH. 



The seventeen eases in which clear luetic histories were obtained, but 

 whicli gave a negative Wasserman reaction were, to a certain extent, 

 disappointing, although the results were not out of accord with the 

 findings of some other observers, as will be shown in the discussion a 

 little further on. The three following are of interest among the syphi- 

 litics who gave negative reactions. 



One case was a patient who had severe general rupial lesions and whose 

 serum was examined one week after the administration of Salvarsan ( "606" ) . 

 The case reacted negatively. However, it must be stated that the patient had 

 been for a long time on very vigorous treatment with mercurials. He had not 

 previously been examined with the Wasserman reaction because of our frequent 

 negative results in cases under treatment. 



Another, which had been under mercurial treatment only three or four days 

 reacted negatively. This soldier originally had a chancre in the inner canthus 

 of the eye in which one of the Board had demonstrated Treponema pallidum. 

 The reaction was made shortly after the appearance of a rash. Whether the 

 absence of the reaction was due to an insufficient liberation of antibodies, or to 

 the treatment received we are of course unable to say. 



A third case of more than passing interest was that of right-sided hemiplegia. 

 This undoubtedly was a syphilitic condition occurring as it did in a young man 

 who gave a history of a typical primary lesion, the usual secondaries, an iritis, 

 and finally, almost two years after infection, a hemiplegia with aphasia. This 

 patient had been thoroughly under treatment with mercurials and iodide, par- 

 ticularly for the month or so preceding transfer to the Division Hospital. The 

 Wasserman reaction was negative. That the condition was really syphilitic was 

 demonstrated to our satisfaction by the marvellous improvement which the patient 

 showed after treatment with Salvarsan. 



The remaining fourteen syphilitic cases which gave negative reactions 

 had all been under treatment for several months. 



A symposium on the theory and workings of the Wasserman reaction was 

 held at the Seventy- eighth Annual Meeting of the British Medical Association, 

 and on this occasion Wasserman (2) made some statements which are pertinent 

 at this point. He said exhaustive investigations have shown that in the majority 

 of recent cases we can cause the disappearance of the reaction through quicksilver 

 treatment. Ehrlich's new arsenic preparation appears to cause in a higher per- 

 centage the disappearance of the reaction; whether permanently or not can not 

 yet be decided. 



Mulzer,(5) working both with tlie original Wasserman procedure and with a 

 modified method, has demonstrated that during a mercurial course the serum 

 reaction may change frequently from positive to negative and again to positive 

 at intervals and concludes that it can not be used to determine the sufliciency 

 of a cure, and that for diagnostic purposes it should not be utilized during or 

 immediately after a course of mercurial treatment. 



It is useless to repeat the various reports in the literature which show the 

 poor results that are obtained in attempting to secure positive reactions with 

 treated cases of syphilis. Harrison(6) quotes various authors who have proved 

 that heated serum loses its deviating power to a certain extent. He found that 

 after heating for ten minutes at 55° C. the complement for hsemolytic amboceptor 

 was lost and that in well-treated latent cases a considerably higher percentage 

 of positive results were obtained by this method than with the same serum 



