Progress in Dermatology

HARVEY P. TOWLE
1908 Boston Medical and Surgical Journal  
Experiments upon apes. -Much valuable information in regard to the reaction was obtained by experiments upon apes which were chiefly carried on in Batavia.8 The results were confirmed later by clinical experiments upon men. Among other facts these animal experiments demonstrated that apes whose serum was free before infection developed antibodies after infection and that in the lower apes, in whose serum syphilitic antibodies were sometimes present under normal conditions, although in small
more » ... though in small amount, infection brought about a marked increase in the amount of these antibodies. It was found, however, that the injections of living or dead syphilitic material could cause an increase of the antibodies only up to a certain point. It was also demonstrated that the antibodies disappeared rapidly after the cessation of the injections. Occasionally antibodies were found in the serum before the appearance of the primary lesion. This was considered to be indicative of an early saturation of the organism. In some cases antibodies were found as early as on the seventh day after the infection. Moreover, these experiments upon apes convinced the writers that the serum reaction was specific in syphilis.8 Clinical results. -Wassermann estimated " that up to December, 1907, his method had been used in over 1,000 cases. The number of investigators who have reported their results is not very large, however. Blaschko5 reports 270 cases, the larger proportion of which gave positive reactions, whereas all of his non-syphilitic cases were negative. Blumenthal and Wile°r eport 50 cases in which both serum and urine were tested at the same time. Forty-one of these cases were undoubtedly syphilitic. They found the reaction positive in both serum and urine in 41 cases, negative in both in 6 cases and positive in the serum but negative in the urine in 3 cases. Stern,8 collaborating with Brück, tested 378 cases of treated and untreated syphilis and obtained a positive reaction in 53%. On the other hand, of 157 non-syphilitic cases, only 2 gave suspicious reactions. Citron°found the reaction positive in 74% of his cases of undoubted syphilis, while not one non-syphilitic case reacted. Hoffmann and Blumenthal13 report a positive result in 80 cases out of 100 in all stages. Meier 18 tested 314 sera, 181 of which were from patients who either gave a history of syphilis or showed the disease clinically at the time of the test. Of the 181 syphilitic sera 81.7% were positive, 2.7% questionable and 15.6% negative. Twenty-one nonsyphilitic sera were all negative. Michaelis 1D got 9 positive reactions in 12 cases of undoubted syphilis, mostly late forms, one weak reaction and 2 negative. Of 26 cases without demonstrable Syphilis 2 gave positive reactions, 1 weak, 23 negative. He also obtained one positive reaction with normal rabbit serum. A moribund case of typhoid which reacted strongly to the Widal test was also positive to the syphilitic test, but in two other typhoids the reactions were negative. Schütze 2Í reports 12 cases of tabes, S of which were diagnosed as syphilitic and 4 as non-syphilitic. The 8 syphilitic cases all reacted positively, the 4 non-syphilitic all negatively. The controls were all negative. Results with normal extracts. -From these results obtained in nearly 1,300 cases it is shown that about 80% of the undoubted syphilitics gave positive reactions to the syphilitic extract (antigen), about 20% a negative reaction and that a positive reaction occurred only exceptionally in non-syphilitic cases. When, however, in the course of extended investigations, non-syphilitic extracts (antigen) were substituted for the syphilitic, it was discovered that they gave results about equal to those obtained with a syphilitic antigen. The claim made by Braun 7 and Weil and Braun 32 that the Wassermann method would give positive results with extracts of normal liver was confirmed by Citron," Landsteiner," Levaditi and Marie 17 and Michaelis.10 Moreover, Michaelis and Citron both obtained positive results with extracts of the fiver of a case dying of carcinoma of other organs. In judging of these results the exceedingly important fact is to be noted that the normal extracts (antigen) gave positive reactions with syphilitic sera (antibodies) only. Weil and Braun,82 who are strongly opposed to the Wassermann method, admit that " the extract of normal liver gives a reaction only with such fluids as show complement fixation with syphilitic extracts also."32 Citron°states that " the reaction obtained with normal liver extracts showed very marked parallelism with the reaction obtained with syphilitic livers but which, nevertheless, manifested certain small differences which were sufficiently well marked to distinguish it from the syphilitic reaction. I could nearly always predict from its behavior with the normal liver extract which case would react positively to the syphilitic liver." Wassermann now admits the correctness of these results. Post-mortem results. -Besides these clinical experiments just recorded we have reports from Blaschko, Lesser and Pick of post-mortem experiments with serodiagnosis. Lesser states that for years he has been convinced by his autopsy records that syphilis of the internal organs is rarely recognized clinically. His results with the sérodiagnostic method have now confirmed his earlier results. Accepting as correct the current estimates of the prevalence of syphihs in Berlin as 20% of the population, he found that of all patients over twenty-five years old coming to autopsy it was possible to demonstrate^i n about 9%, or about one half of the syphilitics, some form of late syphilis of the internal organs which also had in most cases not been recognized clinically. As Lesser and Michaelis obtained at autopsy a positive reaction in about 52% of those
doi:10.1056/nejm190810151591605 fatcat:jb2y2smwhvg6hf2hrhboxleeua