118 



if by tliemselves they would produce 

 hemolysis. 



All these indispensable complemen- 

 tary tests having been perrormed so as 

 to make sure of the working of all the 

 elements entering into the reaction, we 

 next carried out the test with the serum 

 of the patients of leishmaniosis. These 

 sera were collected, separated from coa- 

 gulirai and inactivated in a water-bath 

 at 56oC., during half an hour, and were 

 then kept on ice until next day when 

 the test was carried out. 



0,2 of seriun were placed in each 

 of seven tubes: each of them received 

 0,2 of a different antigen except the 

 last one which remained as control of 

 serum. We next added the quantity of 

 complement determined by the previous 

 titrations and filled all the tubes up to 

 2 cc. with saline solution at 0,85 o/o. 



The tubes were then placed in a 

 water-bath at 37oC. to undergo the first 

 incubation for the space of an hour. 

 An hour after, we added the sheep 

 corpuscles (5 o/o emulsion in saeine solu- 

 tion) sensitised with 2 to 3 hemolytic 

 imits. Reading was done at the end of 

 an hoiu' when controls were completely 

 hemolysed. 



With this technic it never happened 

 for serum of patients of leishmaniosis 

 alone, on whom a careful clinical obser- 

 vation had excluded syphilis, to give posi- 

 tive WASSERMANN tests. 



Of all the cases we observed, all 

 the ones in which positive WASSER- 

 MANN tests were obtained were found 

 to be suffering also from syphilis and 

 specific treatment would support our 

 views. In these cases the ministering of 

 tartar emetic by GASPAR VIANNA's pro- 

 cess was not enough to completely cure 

 the patient and specific antisyphilitic 

 treatment would hasten and complete 

 the treatment. This was thus thera- 

 peutic proof to confirm the clinical one 

 and the result of the WASSERMANN 

 test. Tartar emetic although taken to be 



an active cicatrisant has no curative 

 action on syphilitic lesions nor does spe- 

 cific antisyphilitic medication, mercury 

 and arsenicals, cure leishmaniosis. In 

 medical littérature there is no lack of 

 observations of cases of leishmaniosis 

 ciu-ed or improved by 914 and even in 

 treatises on patholog}' 914 is currently 

 prescribed in' the treatment of this di- 

 sease. In leishmaniosis americana we 

 never observed a case to be cured or 

 improved by this treatment: the only 

 patients that profit and profit conside- 

 rably by this treatment are the ones 

 suffering at the same time from syphilis. 



Out of the patients we observed, 

 one of them, the patient of observation 

 27 died: as this observation is of some 

 interest since it was a case of mixed cuta- 

 neous leishmaniosis and terciary syphi- 

 lis with WASSERMANN test strongly 

 positive with the sLx antigens used and 

 absence of total hemolysis with all of 

 them,we describe the clinical case and 

 the results of the autopsy carried out 

 in the Department for Pathological Ana- 

 tomy of the Instituto Oswaldo Cruz by 

 the assistant Dr. GEZAR GUERREIRO 

 to whom we are very much indebted 

 for the information given. 



Obs. XXVII.— C. F.— Subject of black 

 colour, with a big ulceration on the nose 

 extending from both sides and destroying 

 the external nostrils: nasal septum des- 

 troyed and bony parts of nose affected. 

 From nose ulceration extended to upper 

 lip, which besides oedema, had a cir- 

 cular ulceration 4 centimetres in dia- 

 meter roimded and with projecting 

 borders. Within mouth could be 

 noted ulceration of tonsils; epiglottis 

 partly destroyed; vocal chords totally 

 ulcerated and destroyed; the patient was 

 almost aphonic, it being almost impos- 

 sible to perceive his words. Pharynx 

 covered by a big ulceration, of irregular 

 borders, rough and purulent surface. 

 Oesophagus affected in the neighbour- 

 hood of the pharynx. On the limbs ulce-^ 



