4 



Scientific Proceedings (35). 



fairly early cases of lues. The reaction does not invariably deter- 

 mine luetic conditions, but is marked in about go per cent, of the 

 cases. I have had my reactions controlled in every case, not only 

 by the clinical history and findings, but by the results of a Wasser- 

 man test done in every case on the serum either by Dr. Kaplan, of 

 the Montefiore Home Laboratory, or by Dr. Warren, of the 

 Cornell Laboratory — to whom I am indebted for these data. 

 In comparing our results, it is a very striking fact that I have ob- 

 tained fewer positive reactions in the case of the so-called para- 

 syphilitic diseases — namely, tabes dorsalis and general paresis. 

 The cause of this discrepancy I am unable to determine. It is 

 possible that it might disappear in a larger series of cases ; it is 

 possible that when lues attacks the lipoids of the central nervous 

 system, it spares those of the red cells ; finally, it is possible that 

 tabes and general paresis give a greater number of positive Wasser- 

 man reactions than corresponds to the proportion of luetic infec- 

 tion among these cases. I have also failed to get a positive reac- 

 tion in three cases of scarlet fever, and in two cases of polycythemia, 

 and in one case of scleroderma, in all of which the Wasserman 

 reaction was positive, but inasmuch as the positive Wasserman 

 reaction in these cases is to be regarded as probably due to a 

 source of unavoidable error resident in the nature of the reaction, 

 I believe that the cobra venom has proven a superior reagent in 

 these cases. In certain types of cases, the method which I have 

 described has a distinct advantage over the Wasserman reaction. 

 In the first place, it is applicable to cases with jaundice ; in the 

 second, it is positive for some time after mercurial treatment has 

 abolished the Wasserman reaction ; and finally, it is positive in a 

 very large percentage of very old, quiescent cases in which Wasser- 

 man reaction is negative. The cases which most closely approach 

 the luetics in point of resistance are some cases of tuberculosis, 

 but they have not as yet proven a source of confusion. In the 

 very early florid cases of lues, with chancre and the first rash, the 

 resistance of the corpuscles to cobra venom is regularly diminished 

 considerably below the normal. 



As regards the theory involved in this reaction, I am unable 

 to advance a very satisfactory explanation. I presume that the 

 well-known relationship of lecithin to the Wasserman reaction, 



