Doubtful Diagnosis
Sir: It would be a brave doctor who diag- nosed syphilis on the basis of an 'infallible' Wasserman reaction (Letters, 24 August). On the evidence produced, the case is far from proven in respect of Lord Randolph Churchill too.
LETTERS
Wasserman himself erroneously believed his test specific. There are many causes of false positives, including the other Trepanematoses — Yaws, Pinta, Bejel etc., other bacterial and viral infections includ- ing glandular fever and tuberculosis. Long term intravenous drug abuse and haemato- logical malignancies may react similarly. Systemic Lupus Erythematosus (SLE) is an auto-immune condition that can present with a periodic psychotic encephalopathy indistinguishable from GPI. It can also give rise to a false-positive Wasserman reaction. Although unlikely, it must surely be on the list of differential diagnoses for Lord Ran- dolph?
The evidence from Egyptian mummies is based not on the presence of a positive Wasserman reaction but on pathognomonic skeletal lesions. Indeed this forms much of the basis of the dispute between the Columbian and Unitarian theories of the introduction or re-introduction of syphilis into Europe in the late 15 century.
R. W. Baker
Bristol General Hospital, Guinea Street, Bristol
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