Diagnosis 727 



shoti — to obtain analogous reaction in syphilis by applying extracts 

 of syphilitic tissues to the scarified epiderm of syphilitics. Some 

 reactions were observed, but Neisser and Bruck found that similar 

 reactions occurred when a concentrated extract of normal liver 

 was applied, and to such reactions which could not be looked upon 

 as specific, Neisser applied the term "Umstimmung." 



After having successfully achieved the cultivation of Treponema 

 pallidum, Noguchi* resolved to try the effect of an application of 

 an extract of the organisms applied to the skin, in the hope that it 

 might provoke a reaction useful for diagnosis. To this end he pre- 

 pared two cultures, one in ascitic fluid containing a piece of sterile 

 placenta, the other in ascitic fluid agar also containing a piece of 

 placenta. After permitting them to grow under strictly anaerobic 

 conditions at 37°C. until luxuriant development occurred, the lower 

 part of the solid culture was carefully cut off, the tissue fragment 

 removed, and the rich culture carefully ground in a sterile mortar, 

 the thick paste being diluted from time to time by adding a little 

 of the fluid culture. The grinding was continued until the emulsion 

 became perfectly clear, when it was heated to 6o°C. for one hour 

 upon a water-bath and 0.5 per cent, of carbolic acid added. When 

 examined with the dark-field illuminator, 40 to 100 dead trepone- 

 mata could be seen in every field. Cultures made from the sus- 

 pension remained sterile and inoculation into rabbits' testicles was 

 without result. 



This extract of the treponema culture he calls luetin. When it 

 was applied to the ear of a normal rabbit, by means of an endermic 

 injection with a fine needle, an erythema appeared, but faded within 

 forty-eight hours, the skin resuming its normal appearance, but 

 when it was applied to the ear of a syphilized rabbit, at the end of 

 the forty-eight hours the redness developed into an induration the 

 size of a pea and persisted from four to six days, disappearing in 

 ten days. In one case a sterile pustule developed. 



Luetin was tested by Noguchi and his colleagues upon 400 cases: 

 146 of these were controls, 177 syphilitics, and 77 parasyphilitics. 

 In the controls there was erythema without pain or itching, which 

 disappeared without induration within forty-eight hours. In the 

 syphilitics at the end of forty-eight hours there was an induration 

 in the form of a papule S to 10 mm. in diameter, surrounded by a 

 zone of redness and telangiectasis. This slowly increased for three 

 or four days and became dark bluish red. It usually disappeared 

 in about a week. Sometimes the papule underwent vesiculation 

 and sometimes pustulation. It always healed kindly without in- 

 duration. In certain cases described as torpid, the erythema cleared 

 away and a negative result was supposed to have resulted, when 

 suddenly the spots lighted up again and progressed to vesiculation 

 or pustulation. In 3 cases there were constitutional symptoms — 

 * "Journal of Experimental Medicine," 1911, xiil, p. 557. 



