indicate a cure.  The whole thing is a matter of judgment on the part of an experienced physician, and to that judgment the patient should commit himself unhesitatingly.  If a patient could once have displayed before him in visible form the immense amount of knowledge, experience, and labor which has gone into the devising and goes into the performing of this test, he would be more content to leave the decision of such questions to his physician than he sometimes is, and would be more alive to its reality and importance.  The average man thinks it a rather shadowy and indefinite affair on which to insist that he shall keep on doctoring, especially after the test has been negative once or twice.

Just as a negative test may occur while syphilis is still actively present and doing damage in the body, so a positive Wassermann test may persist long after all outward and even inward signs of the disease have disappeared.  These fixed positives are still a puzzle to physicians.  But many patients with fixed positives, if well treated regardless of their blood test, do not seem to develop the late accidents of the disease.  If their nervous systems, on careful examination, are found not to be affected, they are reasonably safe as far as our present knowledge goes.  People with fixed positives should accept the judgment of their physicians and follow their recommendations for treatment without worrying themselves gray over complications which may never develop.

+Practical Points About the Test.+—­Certain practical details about this test are of interest to every one.  Blood for it is usually drawn from a small vein in the arm.  The discomfort is insignificant—­no more than that of a sharp pin-prick.  Blood is drawn in the same way for other kinds of blood tests, so that a needle-prick in the arm is not necessarily for a Wassermann test.  There is no cutting and no scar remains.  The amount of blood drawn is small and does not weaken one in the least.  The test is done on the serum or fluid part of the blood, after the corpuscles are removed.  It can also be done on the clear fluid taken from around the spinal cord, and this is necessary in certain syphilitic nervous diseases.  There is nothing about the test that need make anybody hesitate in taking it, and it is safe to say that, when properly done, the information that it gives is more than worth the trouble, especially to those who have at any time been exposed, even remotely, to the risk of infection.  But the test must be well done, by a large hospital or through a competent physician or specialist, and the results interpreted to the patient by the physician and not by the laboratory that does the test, or in the light of the patient’s own half-knowledge of the matter.

Chapter VII

The Treatment of Syphilis

GENERAL CONSIDERATIONS