SYPHILIS 107 



disease remains absent. How long, it is impossible to say ; prob- 

 ably two years is about the minimum. Hence the Wassermann 

 reaction supplies information of great value in the mercurial 

 treatment. 



(a) If the reaction does not disappear under mercury, the drug 

 is unsuitable to the case, or is not given in sufficient amount, or 

 not in a suitable form. The dose or the method of administra- 

 tion should be changed, or "606" given. I believe it will be 

 found in most cases that efficient inunction gets rid of the reac- 

 tion most quickly (I have had comparatively little experience of 

 injections), but I am under the impression that grey powder is 

 quite as efficient for the ultimate cure, if not more so. 



(b) When the patient has had a negative reaction for what is 

 considered to be a sufficient time, the drug should be stopped for 

 at least three months, and the blood tested again. If the reac- 

 tion has returned, the treatment must be resumed. If it is 

 still negative, it should be tested after three months more, and if 

 still negative, I believe it is safe to say that the disease is cured. 



7. After " 606 " (salvarsan), as a rule the reaction begins to 

 get weaker from the first, and may disappear in anything from a 

 fortnight to three months. Occasionally, however, it becomes 

 much stronger, and may persist for months, when it gradually 

 fades away ; an increased reaction is not necessarily a bad sign 

 after an injection. Usually when the reaction becomes negative 

 after " 606 " the patient is cured ; relapses, after a negative 

 reaction, in my experience at least, are less frequent than after 

 mercurial treatment. 



8. It is now the accepted teaching that a patient who shows a 

 persistent negative reaction is cured and is reinoculable. There 

 is now supposed to be no immunity subsequent to an attack of 

 syphilis ; a person either has the disease, or is susceptible to it. 

 But the rule that a persistent negative reaction necessarily indi- 

 cates complete cure must 'be qualified a little. It is, I believe, 

 quite true of early cases, but in late tertiaries it is undoubted that 

 the reaction may disappear during a latent period and recur sub- 

 sequently, or that syphilitic manifestations may occur (and be 

 cured by mercury or " 606 ") with a negative reaction in very old 

 cases. In most cases, however, the rule is true, and when a 

 patient, not under the influence of mercury, shows a negative 

 reaction on two occasions at intervals of three or six months, I 

 believe we are justified in regarding him as cured. 



