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Article
December 1914

THE COMPLEMENT-DEVIATION TEST WITH BESREDKA'S TUBERCULIN AND THE OCCURRENCE OF TUBERCULOSIS AMONG SYPHILITICS AS DIAGNOSED BY THIS TEST

Author Affiliations

PITTSBURGH

From the Pathological and Research Laboratories of the Western Pennsylvania Hospital.

Arch Intern Med (Chic). 1914;XIV(6):786-803. doi:10.1001/archinte.1914.00070180019003
Abstract

Although tuberculosis is one of the most common of infectious diseases, it is one of the most difficult to diagnose in its early stages. Very many cases progress to spontaneous recovery without ever giving the slightest possibility of diagnosing the process, and only the statistics of post-mortem examinations show how frequently healed and unhealed undiagnosed tuberculous conditions have existed. It is true that by means of the von Pirquet test many cases in which tuberculosis has existed some time during the patient's life can be diagnosed, but the extreme sensitiveness of this test makes it impossible to differentiate cases in the active stages of the disease from those in which the process of the disease was arrested. For this reason the results of the von Pirquet test, though valuable for the exclusion of tuberculosis, are of little value for the diagnosis of the disease, especially in adults.

References
1.
Besredka, A.:  Compt. Rend. Acad. d. Sc. , 1913, clvi, 1633.
2.
Besredka and Manoukhine :  Compt. Rend. Soc. Biol. , 1914, lxxvi, 180.
3.
Dovidowitch reports ( Deutsch. med. Wchnschr. , 1914, No. (1) , p. 21)
4.
Bronfenbrenner, J.:  Proc. Soc. Exper. Biol. and Med. , 1914, xi, 92.Crossref
5.
This emulsion of lipoid was anticomplementary in the dose 0.6 c.c.
6.
The weakening of the Wassermann reaction, March 30, in the Rabbits 100 and 117 (which did not receive any salvarsan), is due to spontaneous cure. They entirely lost their Wassermann reaction when tested April 10.
7.
I noticed in two cases some change in the strength of the tuberculous reaction under the influence of salvarsan treatment. Whether this change is due to the effect of salvarsan on tuberculous processes, or whether salvarsan may exert direct influence on the serum reaction, is a question studied at present in my laboratory. I wish to express here my indebtedness to Drs. Schildecker and Walker, who kindly offered their cases for the study of the effect of salvarsan treatment upon the deviation test with the tuberculin.
8.
This number comprised cases of active tuberculosis mostly. There were, however, among these twenty-seven cases in which, although there was a very definite history of tuberculosis, no active symptoms had been present for a number of years.
9.
Bronfenbrenner, J.:  Proc. Soc. Exper. Biol. and Med. , 1914, xi, 92.Crossref
10.
Though the number of cases to which this test has so far been applied by me is too small to claim for it unquestionable value, yet the results obtained are sufficiently constant to consider it as additional proof of tuberculosis with other evidences pointing in the same direction. The technic of this test is the following: Fresh serum from the suspected patient is mixed with tuberculin of Besredka in relation 10:1, and 0.05 c.c. of this mixture is injected into the skin of a normal guinea-pig, after the mixture is allowed to stand at room temperature for three hours. Two or three hours after the injection — in case the serum used was tuberculous —the guinea-pig presents thermic reaction, and at the end of twenty-four (forty-eight) hours a local reaction similar to the tuberculin reaction follows. Each series of guinea-pigs is accompanied by a control guinea-pig receiving intradermally the double dose of tuberculin alone. In addition to this, as a control for the serum, each guinea-pig is injected on the side opposite to that of the test injection with the double amount of the suspected serum alone. The results are taken only in those cases where the controls do not show any reaction. This precaution is necessary because some serums show a tendency to cause a local irritation.
11.
Since last February I have been studying on a large series of infants, in collaboration with Dr. Pease, the comparative value of the von Pirquet and complement-deviation test. Though this study is incomplete as yet, it is already apparent that accepting the known diagnostic value of the von Pirquet test on infants, it offers a very favorable control to the serum test, thus adding an additional proof of the specificity of the complement-deviation test with Besredka's antigen.
12.
This group of individuals was not selected in any way, but simply represents the cases in which I was permitted to perform a von Pirquet test as a control to the serum test. The number of cases is comparatively small, but I was unable to have the von Pirquet performed on all cases on account of the desire to avoid the unnecessary inconvenience to the patient incidental to this test.
13.
This number probably is still smaller, as among those classed as nonsyphilitics there may be a certain number of cases of treated or cured syphilis which on account of the absence of definite symptoms and in view of negative Wassermann do not confess a specific history. I had the opportunity of discovering by means of Noguchi's luetin test at least one such case in my series. After the patient under the weight of the evidence, admitted the infection 18 years before, it was duly transferred into the group of treated syphilitics in my series.
14.
Inman, Compt.  Rend. Soc. de Biol. , 1914, No. (4) , p. 251.
15.
Bronfenbrenner, J.:  Science , 1914, xxxix, 804
16.
 Proc. Soc. Exper. Biol. and Med. , 1914, xi, 92.
17.
Debré and Paraff:  Compt. Rend. Soc. de Biol. , 1911, (July 8) , 16, 23, 28.
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