In 1906 the medical world manifested great enthusiasm over the announcement by Erick Wassermann, of the discovery of a test for "syphilis." Before the invention of the test they were never sure whether or not a patient had "syphilis;" since its invention they are equally uncertain. Indeed, they do not yet know what the test reveals. How do they know that the test reveals "syphilis" unless they know that there is such a disease as "syphilis?" How do they know what the blood condition is that gives a positive test?

   The presence of "syphilitic infection" is supposed to result in changes in the biochemical properties of the blood serum and the tests are supposed to reveal, not the germ, but the blood changes. Since the germ gives off no toxin, the blood changes are not likely to exist. However, if they do exist they should be present in greatest quantity when the germs are most prevalent. The test should not be positive one day and negative the next.

   It was early recognized that the test was not fully reliable. Noguchi, whom Parran calls great, pointed out that the same "syphilitic" serum will give all kinds of Wassermann ' reactions from completely negative to strongly positive, depending on how the test is made.

   A lady in New York City went to a physician who suspected her of having syphilis. He took a blood sample to have a Wassermann test made. This he sent to a private laboratory. The lady on the same day had another physician send a blood sample to the Board of Health laboratory for a test. When the reports were received, the Board of Health test gave a negative reaction, that of the private laboratory a strongly positive reaction.

   One shudders when he contemplates the potential power for damage of a test like this. Interpret this anyway you please, it is not encouraging. Say that somebody's technic was faulty. Say that the doctor and the private laboratory were working together in the interest of each other and not in the interest of the patient. Say that somebody did not know how to make the test. Say that a few hours difference between the time the two blood samples were taken were sufficient to account for the differences in the reaction. Explain it as you will, the fact still stands out that one may have syphilis at the same time that he or she does not have it, so far as the test is concerned. This does not bring up a very pleasant picture in one's mind.

   Drs. Lydston and Stillians of Chicago, Krauss and Kahn of Memphis, and Dock of St. Louis, are among those, who, more than once, have pointed out the shortcomings and undependability of the Wassermann test. Kahn says, "it is evident *** that in every syphilitic stage isolated cases are found which will not respond to the Wassermann test." Stillians asserts that "the blood of a healthy baby less than two weeks old will give a positive Wassermann." There are some who are said to get the "Wassermann habit." They show a Wassermann plus throughout life, "even though the syphilis has been brought under control. "These cases are said to be "Wassermann fixed." In his Race Decadence. Wm. S. Sadler, M.D. admits that "the Wassermann test is not infallible."

   It is known that many conditions other than "syphilis" give a positive Wassermann. The Revue de Medicine, Paris, (Dec. 1920) carries an exhaustive article by the Chief of the Faculty Clinic, A. Touraine, entitled "La Reaction de Wassermann en de la Syphilis" (Wassermann Reaction outside of Syphilis), in which he says: "Almost all the maladies which respond to the positive Wassermann are characterized by a rapid and intense deglobulization. This deglobulization is most marked in diseases due to parasites which live in the blood. A number of tropical diseases have been found to give positive reactions. Positive reactions were also found in sleeping sickness by Hallock, Jakimoff, Schilling and others. Eichelberg obtained ten positives out of 25 cases of Scarlatina. Laederlich found positive reactions in measles. Ravout found positives in starch poisoning. In the study of pneumonia Weill obtained 23 positives of 23 cases.

   "Bacillary diseases, especially pulmonary tuberculosis, offer a truly extraordinary collection of positives.

   "Positive reactions are sometimes found in diabetes, alcholism and morphinomania.

   "Nanta and Joltrain obtained three positive Wassermanns out of four cases of lymphatic leukemia. Ten out of eleven cases of myeloid leukemia were obtained by Bruck, Nanta and Joltrain."

   Besides yaws or frambesia, Dr. Becker says "very strongly positive blood tests occasionally are seen in patients who are seriously ill with pneumonia, scarlet fever, malignant endocarditis (a heart infection), leprosy, various diseases of the blood, and generalized cancer."

   The April 1926 issue of Southwestern Medicine says of the Wassermann test: "It is not specific, *** fever at times will give a positive test, and when repeated after the fever is gone will yield a negative reaction; constipation will give a positive test; jaundice at times gives confusing reactions. Tuberculosis may give a positive reaction." To add to this J. DeQuer, M.D. of Los Angeles, tells us that he obtained a positive Wassermann in 400 cases of constipation, and that after the constipation was corrected by diet, etc., 364 of these cases gave a negative reaction.

   If starch poisoning gives a positive reaction in 40% of cases, and almost everybody is starch poisoned (a condition that exists today), one may readily see the enormous number of cases of "syphilis" this test would reveal in our population. This may help to account for the great number of Wassermann positives found among the starch-fed negroes of the South.

   That diet influences the test has long been recognized. For years Dr. Tilden of Denver, has said "If the advocates of the Wassermann test would like, I will obligate myself to prepare any number of syphilis-free cases to show a Wassermann positive test, and then immediately after cause the same subjects to show negative reactions; and the preparation of both conditions will be made with food."

   John R. Williams, of Rochester, N. Y. writing in the American Journal of Syphilis, for April, 1912, under the title, "A Study of the Wassermann Reaction in a large group of supposedly non-syphilitic individuals, including large groups of diabetics and nephritics," says in part: "As the nutrition of these cases was improved by proper dietetic measures, there was a coincidental improvement in the Wassermann test." Thus in each instance where a positive Wassermann test was obtained the diabetes was very severe. He adds:

   "The more plausible explanation is the one which has already been suggested. It would seem that there is a relationship between the nutritional states of these individuals and the variation in the Wassermann reaction. It was observed that the positive and partial reactions occurred when the patients for a long time had been on a diet far below the point of minimal basal metabolism and were suffering severely from imperfect nutrition."

   R. B. Pearson, of Chicago, says in his Drugless Cures, "Oscar Jones, M.D., of Indianapolis, tells me that the Wassermann test only indicates the condition of toxicity of the body, and there is no relation between a positive Wassermann and the presence or absence of syphilis whatever. Further, he says, any one who eats meat to excess may get a positive Wassermann at any time; or cut out meat entirely, cleanse the meat toxin from the intestines with frequent enemas and eat sugar to excess before the test, for a negative Wassermann."

   In going over the reports of tests carried out on negroes in different sections, one thing struck me rather forcibly: namely, more so-called "syphilis" was revealed by the Wassermann dragnet in the economically most depressed negroes than in those who have better food and care. Starch-feeding groups show more positive Wassermans in their investigations. The relation of poor nutrition to so-called "syphilis" is amply demonstrated by its so-called prevalence among the pellagrous-diet fed negroes of the South.

   Alterations in the body's defense mechanism change the test. Prof. McDonagh, of Loch Hospital, London, recognizes this fact and says: "I now practically never do a Wassermann in this stage (after the 4th year) for the simple reason that a positive reaction may only mean that the patient's protective mechanism is working well and retires no stimulus." He adds that malaria and "other diseases" also produce a positive Wassermann reaction.

   Other things than diet affect the test. In an article on "The Interpretation of the Wassermann," In the New York Journal and Record, 1922, page 514, Dr. Sydney Wallenstein, of Baltimore, Md., says, "Contaminated blood may give falsely positive reactions." "The injection of alcohol previous to taking blood tests will render reaction negative." Even the very drugs used to treat "syphilis" alter the reactions. Accurate tests show that iodine, arsenic and mercury, drugs used in treating the supposed disease, affect the test. Ether and chloroform narcosis gives a positive Wassermann. Food, alcohol, drugs, disease, the state of nutrition, and so many other things affect this supposed test, that it is absolutely unreliable, even if there were really such a disease as "syphilis", a thing I positively deny.

   Variations in the test also affect the outcome. Thomas and Ivy, two standard medical authors, say, Applied Immunology. Page 101:

   "1. the marked discrepancies between the results of the Wassermann test and the clinical findings in many cases are causing skeptical clinicians to lose confidence in the value of the reaction, and thus they are being deprived of an important diagnostic agent.

   "2. A great many unfortunate persons are being treated for syphilis who have not and never had syphilis, as the result of weakly positive and doubtful reports of workers using these antigens."

   They also say: "Schamberg, Kolmer, and others report that they obtained positive Wassermann reactions, in using the cholesterinized antigens in over 28 percent of twenty-two cases of psoriasis (itch), in a great many of which syphilis could almost certainly be excluded, thus providing evidence that weak reactions do not necessarily mean syphilis, and that a diagnosis of syphilis cannot be based on weak and medium inhibitions when they are employed. We hold that weakly positive reactions with syphilitic liver-extract mean nothing but syphilis. Even though it were true that the cholesterinized antigens give a more 'delicate' reaction and may furnish positive results in cases of syphilis that are negative to the syphilitic liver-extract, it is a very much less serious error to overlook an occasional case of syphilis than to saddle a diagnosis of the disease with all it entails on a patient who does not have the disease."

   The meaning of this last paragraph is simply that:

   1. Cholesterinized antigens frequently disclose syphilis where none exists; and

   2. Syphilitic liver-extract frequently fails to reveal syphilis where it does exist

   A positive reaction with cholesterinized antigens does not necessarily mean "syphilis" and a negative reaction with syphilitic liver-extract does not necessarily mean the absence of the disease. Surely the reader is ready to give up all faith he may have had in the test. Much more interesting data of a similar import could be given from these authorities but it is hardly necessary to multiply testimony at this time.

   Dr. W. A. Evans, whose How to Keep Well column appears in many daily papers, wrote, in answer to questions (Sunday News. New York, May 25, 1922): "In the competition between laboratories there is some tendency to advertise such claims as 'We get a larger proportion of positive Wassermanns than other laboratories.' This claim is not untruthful necessarily. By varying the methods one way or the other the test can be made more sensitive and the result may be as advertised.

   "But there is this to be said: The Wassermann test is not specific for syphilis. It is most dependable when it is just so sensitive, (How sensitive? — Author). If, on the other hand, it becomes too sensitive, it loses value, just as it loses it when it is not sensitive enough.

   "What is the final conclusion? Shall we pay no attention to the Wassermann reactions? Shall we quit having them. made? I know of no one (using them — Author) in favor of that. With all its shortcomings, the Wassermann test is a standard procedure and should be continued."

   It is valueless, but since it is a "standard procedure" keep up the fallacy. It fools both the doctor and the patient, but the deception is standardized. Let's keep it up.

   In an address at the Conference on Venereal Disease Control Work, Washington, D. C., Dec. 28-30, 1936, Published in Supplement No. 3, to Venereal Disease Information, issued by the U. S. Public Health Service, Dr. Parran said: "We have learned from many check tests that many state and private laboratories are inaccurate in their examinations. The examinations for syphilis are so insensitive in some laboratories that cases of syphilis are missed. In others they are so hypersensitive that certain persons who are not suffering from the disease are labeled as syphilitic."

   How can it be known that the test is just right, that it is neither too sensitive nor under sensitive? How can they ever be sure what this reveals? It is obvious that they can never be sure what the reaction means.

   The various stages of "syphilis" give a varying percentage of positive and negative reactions. No reliance can be placed upon it in the primary stage, according to the best known medical authorities. In the second stage a positive reaction occurs in not more than 85 percent of cases. In the so-called tertiary stage only 70 percent give a positive result. Some authorities report even lesser percentages than these. A positive reaction occurs in scarlatina, pellegra, Hodgkin's disease, malaria, jaundice, diabetes, pregnancy, and a number of other diseases. Yaws, a tropical disease, gives a positive Wassermann. So, also, does nodular leprosy.

   The Department of Health, of the city of New York, maintains a laboratory where various laboratory tests are made without cost to the doctor or his patient. Glass containers are supplied to the physician in which to send blood samples to the laboratory. Around these containers are wrapped blanks to be filled out by the physician and which, after being properly filled, are sent along with the blood sample to the laboratory. On the blank that is filled out when a Wassermann test is desired, the physician is asked: "If result of examination is negative do you wish the department to consider the case as one of syphilis?"

   What can a question of this kind mean. Does it mean that the test is not reliable? Does it mean that one may have syphilis and the test show him not to have it? Does it mean that the profession and the Boards of Health, themselves, do not trust the competency of the test? If it means any of these things and, as I shall show, it means all this and more, the patient cannot reasonably be asked to place his trust in the test.

   In a paper on "The Skin and Syphilis," read before the Academy of Medicine, on Jan. 15, 1926, Dr. Howard Fox, of New York City, said: "The tendency to place undue emphasis on the Wassermann test is unwise. It should be given due consideration but not relied upon to the exclusion of clinical evidence. If leprosy can be eliminated, a strongly positive test indicates syphilis. A negative test, however, by no means excludes a syphilitic infection, as is frequently shown in the case of typical gummas of the skin. Examination of the spinal fluid may show a positive Wassermann test in cases where the blood examination is negative. Even the spinal examination may be negative."

   Dr. Richard C. Cabot of Harvard University and the Massachussetts General Hospital, says: "The Wassermann test has about it a great deal that we do not know. We do not know for certain that a person with a persistently negative Wassermann reaction does not have syphilis. In a few cases of syphilis we have positive evidence of syphilis on the surface of the body despite a negative Wassermann." This statement is made only a few paragraphs after he says "syphilis can imitate any kind of skin disease, and it is not worth while even to try to recognize it."

   Now you see it and now you don't. We can't tell whether it is syphilis or blackheads without a Wassermann test, but we know that it is syphilis even if the Wassermann does say no. If Dr. Cabot knows any more jokes he ought to tell them.

   Parran says "one should always remember that there is a possibility of error in so delicate and complicated a procedure. In the absence of a history of syphilis and without symptoms and physical signs, no person should be labeled a syphilitic on the basis of a single laboratory test." But if we cannot rely upon one test how may we rely upon two or three? Do we reach certainty by the multiplication of uncertainty? Can we arrive at fact by multiplying error? Is not Dr. Tilden right when he declares: "But it is too childish to be taken seriously; for it is like a game of blind-man's buff — now you see it and again you don't. This week, this month, this year it is Wassermann positive; next week, next month, next year, negative. Now you have it, and now you don't; proving that the specific cures for today, for next week, for next year; but the cure does not stay putl Once syphilitic, always syphilitic — at times I Why not all the time, or none of the time after being cured?"

   In the Cincinnati Journal of Medicine. Vol. IX, 1923, page 144, Dr. C. J. Broeman says: "A positive Wassermann does not always mean syphilis." "The blind dependence which so many physicians are now placing upon this blood test is a very dangerous state of mind, and efforts should be made to correct it."

   In Feb. 1928, The Journal of the American Medical Association published a report of 331 autopsies performed by Dr. Douglas Symmers, Assistant Director of the Bellevue Hospital Laboratories; Dr. Chas. G. Darlington, and Helen Bittman, assistant in the Bellevue Laboratories, in which these investigators state that they have reached the conclusions that:

   "The Wassermann test gives a negative reaction in from thirty-one to fifty-six percent of cases in which characteristic anatomic signs of the disease ("syphilis") are shown by autopsy; *** the Wassermann reaction is positive in at least thirty percent of cases in which it is not possible to demonstrate the anatomic lesions of the malady by autopsy. *** It (the Wassermann reaction) is not a specific action, but occurs in conditions other than syphilis, and it does not always occur in syphilis. *** the generation that holds the responsibility of the future is being inoculated with an almost reverential respect for artificial methods that neither clinician nor pathologist can explain or control."

   The test, let me add, is frequently alternately positive and negative in the same individual; is, also, often negative when the blood test is employed and positive when a spinal test is made, or vice versa.

   Now, since the clinician cannot determine with any degree of certainty whether you do or do not have the disease, as I have shown in a previous chapter, and since the laboratory ex-spurt and his tests are as unreliable as a weather forecast, the only way you can be sure you have the disease is to die and let them find out at the necropsy. But suppose there is no such thing as "syphilis" — what then are these "characteristic anatomic signs"? They are not. They are not "characteristic". No disease presents either a symptomatology or a pathology that is clean-cut and characteristic.

   Parran says, "Positive blood Wassermann tests are not a complete index of the amount of syphilis. One-third of patients with beginning nervous system involvement show a negative test." He further says: "After 30 years of using serodiagnostic tests, they are still purely empirical. We do not know that a negative test in a person who has had syphilis does not mean that the disease is cured. We are not sure that a persistently positive test means that organisms persist. We think it does, but positive blood tests for other diseases — typhoid, diptheria, for example — persist after the living organisms have been killed off. There is no way of determining accurately the time when the last syphilis organism has been exterminated from the body."

   Yet these men want every man, woman and child in the land tested for "syphilis" by this same unreliable test, tomorrow. They would deny marriage to the purest young woman in the whole land until she has subjected herself to a test for this medical nightmare, "syphilis". They would compel her to stake her all upon a test that is not nearly as reliable as a weather forecast. Becker would repeat the test every year or two throughout life, for, he thinks the repetition of "the routine blood tests" can alone prevent large numbers from becoming "hopelessly crippled by syphilis before" they are "aware of its presence".

   The Wassermann test is of no earthly value, except as a means of perpetuating a delusion. It can be used to scare the wits out of you, and blacken your life for the rest of your days, if you do not commit suicide as many do. If the test shows positive, you will be declared to be "syphilitic". If it shows negative, the physician will not be sure whether you have the disease or not.

   In the Journal of the American Medical Association, Oct. 23, 1926, James Herbert Mitchell, M. D., calls attention to the unreliability of a weakly positive Wassermann reaction and states that much of his present work consists in trying to convince patients that they do not have the disease. He says: "The value of the various 'serums' and blood tests has been extolled to the point at which the uneducated or the unthinking layman is led to believe that a blood test is infallible. Add to this the fear of venereal disease implanted in his mind by the anti-venereal propaganda, and we have a combination of circumstances with the greatest possibilities of harm. The time has come, I believe, when steps should be taken to give the layman and the general practitioner a word of caution."

   Then coming to the mental effects of the pronouncement of "syphilis" he tells us: "One patient of mine, as a result of a slightly positive Wassermann reaction ten years ago, has wandered from coast to coast, begging physicians to treat him. As many of the reputable men have refused to do so, he has been obliged to step down the scale in order to find men who would treat him. He carries about with him his own favorite type of spinal puncture needle, and when last seen had had twenty spinal punctures done by men in various parts of the country. The reports on his spinal fluid have been uniformly negative, but the one slightly positive blood Wassermann reaction ten years ago was sufficient to upset his whole life.

   "In no class of patients does the slightly positive Wassermann reaction cause so much harm as in the candidate for marriage. The very laudable movement for such examinations set on foot by various agencies, insisted on by some eminent divines of the Episcopal Church and enacted into law in some states, has undoubtedly produced good results; but when a slightly positive Wassermann reaction is returned a day or two before the ceremony is to take place, the situation may be nothing short of tragic. In the last year I have struggled with five such cases . . . . ."

   This article by Dr. Mitchell evoked an editorial comment from the Medical Journal and Record (New York), Sept. 21, 1927, in which the question is raised as to whether the Wassermann test has not done more harm than good. The Record says, in part:

   "Dr. J. H. Mitchell, in a paper before the Section on Pathology of the American Medical Association in April, 1926, wisely remarked that many laymen have the impression that the practice of medicine has kept pace with the mechanical developments in other fields of endeavor and that diagnoses are now made with mechanical, if not mathematical, precision, thanks to the various tests employed. He might have added that a great body of physicians seem of the same mind or they would use much better judgement in interpreting or even in using these tests. The routine examinations through which so many patients are run nowadays, if they do not give them this impression must give them the opposite one that they are being imposed upon, and where their faith is stronger they may even end most disastrously. *** On the whole we wonder whether the Wassermann has done more harm than good, for a negative reaction following treatment of an undoubted case does not mean that the patient is really cured, though unfortunately he usually interprets it in that fashion.

   "Dr. Mitchell gives other illustrations that would confirm our questioning as to whether humanity might not be as well off if the complicated and variable ingredients for the Wassermann test were dumped into the ocean along with the bulk of the Pharmacopoeia, as suggested by Dr. Holmes, though this would be mixing the elements considerably. We see no reason why it is not more important that one innocent person should be saved from mischief by so doing than that evidence of real infection should be given some confirmation. The medical profession cannot be responsible now for the advertising given this test outside their own offices, but they can be more judicious in using this and any other test indiscriminately and without due consciousness of its nature. "Many patients undergoing a so-called routine or thorough examination object to (and all must find it anything but pleasant) the taking of blood. In so doing they show good sense beyond that of those who insist on this performance without the best of reason."

   As before pointed out the unreliability of the Wassermann test was early recognized. Various experimenters made efforts to "improve" the test. Many modifications of the test have been made, one of the first of these being the Nogouchi test. At the present time many pathological laboratories never make the original Wassermann test. Let us give a little attention to some of these "improved" tests.

   Becker says of the original Wassermann, that "it soon was found that the test was not only nonspecific in that conditions other than syphilis resulted in a positive test, but that it often was negative in the presence of the disease. The original test has been modified by many workers, with improvement in sensitivity and specificity. Another type of the test, the precipitation test, has been introduced more recently and has gained favor on account of its simplicity and economy. At present there is no particular choice between the complement fixation and the precipitation reaction, but a combination of the two performed on each serum from the blood gives more information than either alone. Good laboratories perform a representative of each of the two types on each serum. If there is any doubt as to the significance of the test it should be repeated. The two forms of test theoretically should not disagree, but occasionally they do. That is why both often are made." So they can disagree, I suppose.

   The Journal of the American Medical Association, July, 10, 1937, says editorially of the "Clinician and the Serologic Test for Syphilis:"

   "The ideal serologic test for syphilis is one that is completely specific (which gives no false positive or false doubtful results in known nonsyphilitic persons). There is no such test." Discussing tests they say "the results of the American serologic conferences" show to be satisfactory — "the Kolmer complement fixation test and the Kahn and Kline diagnostic (not the Kahn presumptive or Kline exclusion tests) —" they say: "Even with these named tests the clinician must remember that false positive (or false doubtful) results may be obtained in about one patient out of a hundred tested, and he must be on his guard against diagnosing syphilis when it is not present and instituting treatment that is not needed."

   The intelligent reader will readily perceive that a test that is capable of showing syphilis where no syphilis exists is not likely to do so only once in a hundred cases. It may do so ninety-nine times out of a hundred.

   The editorial further says: "The ideal serologic test is one that is so sensitive as always to detect syphilis when it is present. There is no such test, *** however, the five tests named in the preceding paragraph — Kolmer, Kahn and Kline diagnostic, Eagle and Hinton — compare favorably with any known tests as to sensitivity in that they are successful in detecting from 70 to 90 percent of positive and doubtful results in known syphilitic population (treated and untreated). The percentage sensitivity in the hands of the originators of these tests is: Kolmer 72.6, Kahn diagnostic 82.3, Eagle 82.6, Kline diagnostic 86 and Hinton 90."

   These tests then are as unreliable as a weather forecast. They not only find "syphilis" where none exists, but they also fail to locate it where it does exist. We may not take at their face value, their accurately determined ratios of sensitivity, even to the first decimal point, for they have no dependable means of checking these tests. Indeed if they had such means they would not need the tests.

   The editorial further says: "To the clinician moreover, specificity is more important than sensitivity. He must remember that, in the laboratory, sensitivity is usually gained at the expense of specificity; as any test is adjusted to give the highest possible proportion of positive results in known syphilitic patients there is a hand in hand increase in the proportion of false positive results in nonsyphilitic patients."

   How is it ever to be definitely known that any particular case is "syphilis" if the test is not dependable? We have previously shown that so-called "syphilis" cannot be diagnosed by the symptoms, nor by the dark-field test.

   The editorial makes the matter more confusing by telling us that the same blood sample may give a positive reaction with one test and a negative reaction with another in the same laboratory. It says: "Many laboratories still perform a complement fixation test with several antigens, e.g., plain alcoholic, cholesterinized or acetone insoluble, or check a complement fixation with a flocculation test or one flocculation test with another. While this type of multiple testing is desirable for intralaboratory check, the reporting of such multiple results to the clinician is often confusing. When the blood specimen gives a negative result with, for example, the Kolmer test but a positive result with the Kahn, this signifies only (a) that the patient has but a small quantity of reagin in his blood and (b) that the Kahn test is more sensitive than the Kolmer. The same thing applies to the different antigens in the complement fixation test."

   Suppose these diametrically opposite results signify what they say they do; does it mean that the Kahn test is so sensitive that it finds "syphilis" where there is none, or that the Kolmer test is so insensitive that it fails to find "syphilis" where it does exist? How is the clinician to know whether his patient has or does not have "syphilis"? The editorial attempts to answer such questions by saying: "If the history is positive and physical signs are present, a single positive test may be accepted. If these are absent, the positive result must always be verified by a repeat test in the same or a different laboratory before the patient is told of the diagnosis or treatment started."

   It should be obvious that if the physical signs are of such a character that the physician can be positive that they are positive, there would be no need for the test. The test came into existence because doctors could not diagnose "syphilis". The same may be said for the "positive" history. The history cannot be positive so long as there is doubt about the real nature and meaning of the past symptoms. What of the repeat test to verify the first test? It is no more dependable than the first.

   The editorial says that the repeat test "is in order to guard against the possibility of false positive results in non-syphilitic persons, a chance ranging from 0.1 to 0.5 percent even with the five tests named, and greater with other tests." Doctors are never anything if not accurate. They know their tests are inaccurate and they can't tell when they are right or wrong (if they could they would not need the tests), but they know to the smallest fraction of one percent, just how often their tests are wrong.

   The reader's attention is especially directed to the falsehood contained in the next statement of the editorial. It says: "The only other diseases or conditions that give a positive serologic test for syphilis are malaria (rarely), yaws, relapsing fever and leprosy (all frequently). In untreated syphilis the range of positivity of the five tests named is from 90 to 95 percent in all stages of the infection."

   We have previously shown that several other diseases besides those named in the editorial as the "only other diseases that are positive," give positive results in the tests and do not deem it worth while to dwell on this here. We pause only long enough to brand the editorial statements as false and to ask: If malaria gives a positive reaction, why does it do so only "rarely"?

   The editorial discusses what it calls the "archaic and confusing system of reporting by plus marks" and says, "many nonsyphilitic patients have been treated for syphilis on the basis that a test reported as 'one plus' means positive, when as a matter of fact it may not mean any such thing. For the plus marks the words 'positive,' 'doubtful' and 'negative' should be substituted without qualifying symbols or adjectives. *** Doubtful would mean that there had been a definite result and that the test should be repeated. False doubtful results in nonsyphilitic persons are more frequent than false positive (from 0.1 to 1 percent with the five tests enumerated, greater with others). However, a doubtful result may mean syphilis, especially if the patient has been previously treated.

   "If the tests are negative there is a 95 percent chance that the patient does not have syphilis (in the absence of previous treatment), but a negative result does not exclude the diagnosis."

   Was there ever such a mad-house? Is there any other field of human activity in which men are so willing to deliberately blind themselves to their own follies? Dr. Tilden says, "I do not believe the profession is conscious of its irregular and guerrilla style of defending its so-called science. It is forced by its confusions to make explanations that do not explain, except to those who are not troubled with thinking." It seems fitting to close this chapter with a quotation from Dr. Logan Clendening. In an article in Plain Talk, April 1930, he says, in discussing the question: Is a patient cured of syphilis?: "About twenty years ago a test known as the Wassermann test was brought forward. *** it was reported that it decided whether a person ever had syphilis, whether the syphilis was cured or whether more treatments were necessary. Therefore it was hailed with great enthusiasm and almost universally carried out in all laboratories and hospitals. I believe that I express the general opinion of clinicians when I say that twenty years of experience with the Wassermann reaction has modified the early enthusiasm very considerably. Many person's who have never had syphilis have positive Wassermann reactions. And no syphilographer on earth would be prepared to say a man was cured on the record of his Wassermann test alone.

   "That this may not appear a personal opinion, let me refer to the statement of Dr. Wile, who is Professor of diseases of the skin at the University of Michigan. In discussing this very point of the determination of the curability of syphilis, he said a year or so ago that we must abandon reliance on the Wassermann and must go back to the old rule proposed by Ricord (who was born in 1799): that when a patient has remained free from all signs and symptoms of the disease for seven years, he may be pronounced clinically cured.

   "Certainly no one can put forward the supposition that Dr. Wile has not had enough experience. No one is prepared to suggest that the technique used in doing Wassermann reactions at the University of Michigan, where he labors, is faulty."