340 BLOOMBERGH. 



From our own limited experience we consider it doubtful if a posi- 

 tive Wasserman reaction is to be obtained as a result of infection with 

 the Bacillus lepra. Before attributing a positive reaction in a leper to 

 his leprosy alone it is necessary to consider the possibility not only of 

 syphilitic taint but also of present or antecedent frambcesia. This latter 

 is especially important when working with leprosy in those parts of the 

 Tropics where yaws is prevalent. Eecently, we have seen a Filipino 

 leper who also showed typical lesions of yaws. 



In yaws we were able to make observations on only two individuals. 

 The serum of one case was forwarded to us by Lieutenant J. E. Barber, 

 Medical Coi-ps, from Corregidor Island, and came from a young Fili- 

 pino adult in the active stage of the disease. The diagnosis w^as based 

 on the clinical appearances and on the presence of Treponema pertetiue 

 in the nodules. The second serimi was obtained from a ten-year-old 

 boy who had long been a frequenter of the skin clinic at St. Paul's Hos- 

 pital in Manila. Both of these sera gave the same strong inhibition of 

 haemolysis that we obtained from our untreated syphilitic cases. The 

 finding confimis the results of many others who have tried the serum 

 reaction on yaws. It will be of interest to add that seven days after 

 treatment with "606" in the Philippines General Hospital, to which 

 we had transferred the boy and where we obtained the blood a second 

 time through the courtesy of Dr. Donald Gregg, the serum reaction of 

 the second case remained positive. Evidently the time was not suffi- 

 ciently long for the substances in the blood arising from the activities 

 of the Treponema pertenue to disappear. Incidentally, the recovery in 

 this case was remarkably rapid, although the boy had done very poorly 

 on the iodide of potash treatment given him at the clinic over a period 

 of more than a year. 



Of the syphilitic cases which gave j)ositive serum reactions few had 

 ever been on mercurial treatment and not one had been recently treated. 

 Four cases gave negative histories of previous syphilitic infection and 

 in two the diagnosis could not have been made without the aid of the 

 Wasserman reaction. 



One patient had been transferred to the Division Hospital with the diagnosis 

 of chronic periostitis, cause tinknown, and had been on sick report at intervals 

 during the preceding eight months, the total period of disability being more 

 than three months. The diagnosis of syphilis was made by us on the strength 

 of a positive Wasserman reaction. The condition began to improve shortly after 

 the inauguration of mercurial treatment and the soldier was subsequently re- 

 turned to duty. 



A second man, "C. P.," had been transferred to the Division Hospital with 

 the diagnosis of malarial fever after a considerable time on sick report. There 

 were no signs or symptoms in this case other than the presence of fever, and 

 the serum was tested in the expectation of obtaining a negative result. The 



