A CUTANEOUS REACTION IN SYPHILIS

1. I have proposed the name luetin for an emulsion or extract of pure cultures of Treponema pallidum which is designed to be employed for obtaining, in suitable cases, a specific cutaneous reaction that may become a valuable diagnostic sign in certain stages or forms of syphilitic infection. 2. The repeated inoculation of either living or killed pallida into the testicles of rabbits leads to a condition in which an intradermic injection of luetin is followed by a well marked inflammatory reaction. A corresponding reaction has been obtained neither in rabbits suffering from active syphilitic orchitis, nor in those in which the condition had been cured by the administration of salvarsan four months previously. Normal rabbits, likewise, do not react to the luetin. 3. The luetin produces a similar cutaneous reaction in syphilitic and parasyphilitic patients that is most constant and severe in the tertiary and hereditary affections. In my series of cases, it was present constantly (100 per cent.) in the manifest tertiary affection, in 94 per cent. of latent tertiary affection, and in 96 per cent. of the hereditary affection. 4. During the primary and secondary stages, the reaction is infrequent, and when present it is of mild degree. An exception has been found in cases in which energetic treatment has been or is being carried out and in which clinical signs of syphilis are absent. Such cases may show a severe reaction. Apparently this is true especially of the cases treated with salvarsan. 5. In certain cases of old infection in which no treatment has been taken and in which no symptoms have appeared for many years, and in the course of which miscarriages have not occurred, the cutaneous reaction has failed to appear. But, despite the absence of symptoms, mothers who have young syphilitic children have usually given the reaction. 6. It remains to be determined in how far the cutaneous reaction with luetin can be used to supplement the Wassermann reaction in determining the complete and permanent suppression of a syphilitic affection. 7. It appears probable that the Wassermann reaction is more constant in the primary and secondary, and the cutaneous reaction in the tertiary and latent forms of syphilis. Moreover, it appears that the Wassermann reaction is more directly and immediately affected by antisyphilitic treatment than is the cutaneous reaction. 8. A more active preparation of luetin can certainly be produced by improved methods. This phase of the subject is being considered at the present time and will be reported upon in a later paper.