I06 CLINICAL BACTERIOLOGY AND HyEMATOLOGY 



the case may be syphilis, though this is unlikely, except in the 

 very early stages. 



2. In the secondary stage practically all cases give a positive 

 reaction. A patient who has a doubtful rash, and who does not 

 give a Wassermann reaction, is almost certainly not syphilitic. 



3. At the outset of the tertiary stage practically every patient 

 gives the reaction, and, if the disease remains active, continues to 

 do so. If the disease becomes latent, the reaction usually be- 

 comes very weak, or may disappear altogether ; but recurs should 

 symptoms recur. In the very late stage of the disease, however, 

 twenty years or so after infection, a definite gumma or syphilitic 

 ulcer may occur, with a negative reaction. This is unusual, and 

 I have seen a positive reaction in a man forty-two years after the 

 sore. 



4. In the " parasyphilitic " affections the reaction may, or may 

 not, be present. In general paralysis it is usually present ; in 

 tabes it is rather more frequently absent than present. The 

 accepted and, as I believe, the correct teaching is that, in the 

 latter disease at least, cases which give a positive reaction should 

 have immediate and energetic syphilitic treatment, which offers a 

 fair prospect of arresting the malady. 



In general paralysis the reaction is almost always present in 

 the cerebro- spinal fluid ; in tabes it is frequently so. 



5. In congenital cases the reaction is usually present, and 

 indeed very strong, even in quiescent intervals, when there is 

 no sign of disease. It is very difficult to eradicate it by treat- 

 ment — indeed, some say impossible, though I have seen cases 

 to the contrary. Apart from this, it probably dies away gradu- 

 ally, though it may persist well past middle life. 



The mothers of children with congenital syphilis usually give 

 a positive reaction. The accepted interpretation of Colles's law is 

 that the mother is actually infected, though in a mild and unob- 

 trusive way. 



6. The effect of mercury is most important to understand. It 

 removes the reaction before the disease is cured. In other words, 

 if the action be watched in a patient under efficient mercurial 

 treatment, it will be found to get weaker, and ultimately to dis- 

 appear. If the drug be now stopped, the reaction will soon 

 reappear, and will gradually become as strong as before. To 

 eradicate the reaction, and, as we believe, to cure the disease, it 

 is necessary to keep on for a long time with mercury, whilst the 



