NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
iii
pitfalls. Farther experiments of a comparative nature will be carried out with
varied preparations of antigen. Given that it is possible to prepare a stable antigen
from congenital syphilitic livers, the method as originally described by Wassermann
will probably prove to give the most reliable results in all classes of cases. The
effects on the Wassermann reaction caused by treatment with Salvarsan have also
been studied, but the results are conflicting and no conclusion could be come to,
except that diminution, if any, does not take place in less than two months. If the
Wassermann test really has to do with syphilitic anti-toxin produced in the patient's
system, it does not seem clear why treatment with Salvarsan should reduce it, nor;
in relation to the endurance of the patient's immunity, desirable that it should do so.
Of course if Salvarsan really kills off all the toxin, no farther anti-toxin can be
produced, and a gradual reduction of the latter must take place; but the slower this
excretion of immunising substance goes on, the better.
Malaria. —There was a rise of 30 per cent. in the number of bloods examined for
malarial parasites. The percentage of positive finds, 13 per cent., was much the
same as last year.
Tubercle. —The number of specimens sent for the detection of tubercle bacilli
fell by 30 per cent., but the proportion of positive results was somewhat greater—23·6
per cent. as against 20 per cent. last year.
Spirochaeta Pallida. —The specimens from macerated foetuses sent by Colonel
Giffard, I.M.S., have been included in the general list this year, but a special table is
appended giving the results obtained with them. No other specimens for the
detection of this parasite were submitted for examination.
TABLE II— cont.
N u m b e r .
Date of despatch.
Number of
pregnancy.
History of former pregnancies.
Notes of fœtus.
Remarks.
Result of
examination.
Specimens from this date were sent in sterile gauze preserved in ice— cont.
50
1912.
25th September . . . First . . .
. . .
Macerated . . . Does not give a history of syphilis. Two suspieious
scars on left skin and periosteal nodes on both
tibiæ.
Negative.
Specimens from this date were forwarded in two lots one portion in formaline, the other in sterile guaze.
51
1912.
6th October . . . First . . .
. . .
Macerated . . . No history of syphilis in either parent . . . Spirochætes present in
fair numbers.
52
14th " . . .
Third . . . Two natural . . .
Do. . . . No history could be got . . . Negative.
53
24th " . . .
Eighth . . . Three abortions . . .
Do. . . .
. . .
D o .
54
26th " . . .
Tenth . . .
. . .
D o . . . .
. . .
D o .
55
28th " . . .
Thirteenth. . . All natural; three still births, three died soon after
birth.
Do. . . . No history of syphilis in either parent . . .
Do.
viii
The large amount of highly technical work which has been accomplished in
addition to the already large volume of simpler routine work speaks well for the
energy and devotion to duty of the staff.
THE KING INSTITUTE OF PREVENTIVE
MEDICINE,
F. MAITLAND GIBSON, M.B., B.SC.,
15 th February 1913.
Director.
xi
(2) Normal saline extract of syphilitic liver. —About 30 c. c. of 1 per cent. saline added. to
every gramme of dry liver powder and kept for a day in a cool place, gives almost the correct
strength of the extract. A series of control experiments have however to be conducted with the
extract on sera known to be syphilitic to find out the exact amount and dilution which is capable
of fixing the complement, but which with normal serum does not fix any appreciable quantity of
it, nor is capable by itself of lysing blood cells.
(3) Guinea-pig's serum drawn fresh on each occasion to supply the complement.
(4) Rabbit's haemolytic immune serum stocked in glass capsules as per instructions given
previously.
(5) Sheep's washed red blood cells also collected. fresh on each occasion.
(6) 1 p e r c e n t . s a l i n e s o l u t i o n .
(7) Some normal human, serum to act as control reagent. By using varying quantities of
the patient's serum in the reaction one will be able to gauge the degree of reaction which can
roughly be indicated by the terms, strong, moderate, weak and trace. This way of measuring
the reaction is useful in finding out the severity of the disease. The technique connected with
this method can be made intelligible by using a table as follows:—
TABLE I—Tabular Scheme of a Wassermann Test on Serum " A ".
Number of Test Tube.
One per cent.
solution
of salt.
Extract of
antigen.
Serum
" A "
under test.
Guinea pig
serum
complement.
—
Suitable dilution
of immune
Rabbit's serum.
Five per cent.
suspension
of sheep's washed
red corpuseles.
—
Interpretation of Results.
Lysis Negative.
Lysis Positive.
A1 contains . . . 13 parts . . . 2 parts . . . 2 parts . . . 1 part . . .
I n c u b a t e a t 3 7 º C . f o r 1 ½ h o u r s .
2 parts . . . 10 parts . . .
I n c u b a t e a t 3 7 º C . f o r 1 ½ h o u r s .
Positive reaction trace . . . Negative reaction in Serum
"A".
A 2 contains . . . 14 parts . . . 2 parts . . . 1 part . . . 1 part . . .
2 parts . . . 10 parts . . .
Positive reaction weak . . . Negative reaction in Serum
" A " .
A3 contains . . . 14 parts . . . 2 parts . . . 1 part of 1— 2
dilution.
1 part . . .
2 parts . . . 10 parts . . .
Positive reaction moderate . . . Negative reaction in Serum
"A".
A4 contains . . . 14 parts . . . 2 parts . . . 1 part of 1—4
dilution.
1 part . . .
2 parts . . . 1 0 p a r t s . . .
Positive reaction strong . . . Negative reaction in S erum
"A".
Control 1 contains . . . 15 parts . . .
. . .
2 parts . . . 1 part . . .
2 parts . . . 10 parts . . .
There is a complement fixing
system in serum " A " and the
result is inconclusive.
Negative reaction due to want of
antigen.
Control 2 contains . . . 15 parts . . . 2 parts . . .
. . .
1 part . . .
2 parts . . . 10 parts . . .
The extract of antigen contains a
complement fixing system. It
is useless and must be rejected.
The result is inconclusive and
the test must be repeated with
another extract of antigen.
Negative reaction due to want of
antibody.
Control 3 contains . . . 16 parts . . . 2 parts . . .
. . .
. . .
2 parts . . . 10 parts . . .
N egative resu1t due want of
complement.
The extract of antigen contains a
substance capable of acting
like complement. It is useless
and must be rejected as it
might cause a weak reaction to
be missed. The result is
inconclusive and the test must
be repeated with another
extract of antigen.
N.B.—When a number of bloods " A ", "B ", " C ", etc., have to be tested, only those operations above the double line are repeated with " B ", " C ", etc. ; Control No. 1 though strictly a control must
be repeated with each serum tested, as these may contain a complement fixing system, not necessarily syphilitic and thus give a wrong positive reaction.
TABLE II.
—
10 per cent.
organ extract.
5 per
cent.
2½ per
cent
l¼ per
cent
Saline.
Serum.
—
5 p e r c e n t . s h e e p c e l l s .
—
Result.
Lysis if syphilitic.
Reaction.
Lysis if non-syphi-
litic.
R e a c t i o n .
A1
3 Vol.
. . .
. . .
. . .
3
3
I n c u b a t i o n a t 3 7 º C . f r o m 1 t o 1 ½ h o u r s .
3
I n c u b a t i o n a t 3 7 º C . f r o m 1 t o 1 ½ h o u r s .
—
Positive trace . . .
+ + + Negative.
A 2
. . .
3 Vol.
. . .
. . .
3
3
3
—
Positive weak . . .
+ + +
Do.
A 3
. . .
. . .
3 Vol.
. . .
3
3
3
—
Positive moderate . . .
+ + +
Do.
A4
. . . . . .
. . .
3 Vol.
3
3
3
—
Positive strong . . .
+ + +
Do.
A 5
Control.
. . .
. . .
. . .
. . .
3
Vol.
3
3
+ + +
. . .
+ + +
Do.
XIV
xviii
From this table it is clear that Salvarsan injection, although it seems to have a marvellous
effect on the clinical symptoms in a short time, does not influence the Wassermann reaction for a
long time to come. It takes at least two months to effect the degree of the reaction to an
appreciable extent. The effect of Salvarsan on the serum reaction cannot therefore be studied
in hospital cases, who cannot remain as in-patients for a long time. The reaction seems to
persist to almost the same degree as before injection for at least a month. Most of the bloods
sent were tested one month after the injection. In four cases bloods sent were tested from 6 to 8
weeks after the injection and in these a small change was observed. It is therefore probably
necessary to examine the blood after 2 to 3 months or even longer to find out the effect of
Salvarsan on the reaction.
As was the case with different observers, I also was able to obtain occasionally a positive
reaction from cases of leprosy and yaws.
CONCLUSIONS.
1. The serum reaction for syphilis possesses a sufficient degree of specificity to make it of
considerable value from a diagnostic and therapeutic point of view.
2. The Hecht-Fleming method has a greatly simplified technique but is of less diagnostic
value especially under Indian conditions.
3. The Original Wassermann test is handicapped in that it depends on a material not
always available, but it is a very sensitive one capable of showing the reaction in very early
cases which were missed by the other methods.
4. Levaditi's modification is probably the most generally applicable. Its sensitiveness is
not much inferior to the Original though it is apt to miss 10 per cent. of very early infections.
The completeness with which the reaction takes place renders it very valuable. It also avoids
many mistakes due to the sudden deterioration of the reagents used in the original method.
5. In primary syphilis, if the test is negative, it should be repeated after an interval as the
reaction may be slow in developing. In secondary or tertiary syphilis the reaction is very
definite unless intensive mercurial treatment has been employed where it may be very variable
or even negative.
6. The effect of Salvarsan on the Wassermann reaction is not appreciably noticeable within
6 to 8 weeks of the injection.
Statement.
TABLE VII.
Number of bloods examined.
History of cases
Wassermann reaction
before treatment.
Treatment.
N u m b e r .
Date of
examination.
N a m e .
Hi story.
Reaction.
Degree
of
reaction.
Treatment.
Reaction
subsequent to
treatment.
Remarks.
Hecht-Fleming Method.
1 14th December 1911.
B., G.H.. . . Anæmia and Cachexia
. . . Positive
. . . Strong . . .
. . .
. . .
2 16th " "
S., G.H. . . . Patches both pustular and serous on face and
neck.
D o . . . .
Do. . . .
. . .
. . .
3 28th " "
K. . . .
. . .
Negative . . .
. . .
. . .
. . .
4 4th January 1912. E. . . .
. . .
Indefinite . . .
. . .
. . .
. . .
5 4th " "
S., G.H. . . . Primary sore two years ago followed by a
rash, fever and sore throat. Suffering from
ulcers on both palms.
Positive . . . Strong . . .
. . .
. . .
6
6th " "
L., G.H. . . . Acute Psoriasis . . .
. . .
. . .
Salvarsan . . . Positive weak. . . .
7 8th " "
R. . . . No obvious signs of syphilis. But had
abortion and macerated foetus.
Positive . . . Strong . . .
. . .
. . .
8 12th" "
V., G.H. . . .
. . .
Do.. . .
Do. . . .
. . .
. . .
9 17th" "
E., G.H. . . .
. . .
Negative . . .
. . .
. . .
. . .
10 17th " "
R. P. . . .
. . .
Do. . . .
. . .
. . .
. . .
11 31st " "
S., G.H. . . .
Vide case 5 .
.
.
.
. . .
. . .
Salvarsan (22nd Janu-
ary 1912).
Positive strong.
12 31st " "
W., G.H. . . . Primary sore four months ago followed by a
rash, sore throat, suffering from periosteal
nodes in front of Tibia, pain in joints,
elbows and ankle.
. . .
. . .
Salvarsan
(28th
November
1911)
Bombay.
Negative.
13
3rd February 1912,
R., G.H. . . .
. . .
Negative . . .
. . .
. . .
. . .
14
3rd " "
M . , G . H . . . .
. . .
Indefinite . . .
. . .
. . .
. . .
15
7th " "
J . . . .
. . .
Negative . . .
. . .
. . .
. . .
16
7th " "
N., G.H. . . . History of syphilis a year ago . . .
. . .
. . .
Mercury for 1 year . . . Negative.
17 7th " "
M., G.H. . . .
. . .
Indefinite . . .
. . .
. . .
. . .
18
7th " "
S . , G . H . . . .
Ulcers on the face, shoulders and back, the
size of the palm of the hand. Infection a
year ago.
. .
. .
Salvarsan (19th Janu-
ary 1912).
Positive strong . . .
Cured.
19
7th " "
G . H . . . .
. . .
. . .
. . .
Salvarsan (16th Janu-
ary 1912).
Positive strong.
20
7th " "
G.H. . . .
. . .
. . .
. . .
Salvarsan (22nd Janu-
ary 1912).
Do.
21
9th " "
S., G.H. . . .
Vide cases 5 and 11 . . .
. . .
. . .
. . . Positive weak . . .
Cured.
22
9th " "
S., G.H. . . .
. . . Negative . . .
. . .
. . .
. . .
23 22nd " "
S., G.H. . . .
. . .
Positive . . . S t r o n g . . .
. . .
. . .
24 28th " "
L . , G . H . . . .
. . .
Do. . . .
Do. . . .
. . .
. . .
25
2nd March 1912.
G.H. . . .
. . .
Negative . . .
. . .
. . .
. . .
26 2nd " "
P. Care of Major C. S. . . .
. . .
Indefinite . . .
. . .
. . .
. . .
27
5th " "
S. G.H. . . .
. . .
Positive . . . Strong . . .
. . .
. . .
28 12th " "
A:K .,
G . H.
. . .
. . .
Indefinite . . .
. . .
. . .
. . .
c o n t
.
Number of bloods examined.
History of cases.
Wassermann reaction
before treatment.
Treatment.
Remarks
Number.
Date of
examination.
Name.
History.
Rea ct i on.
Degree
of
reaction.
Treatment.
Reaction
subsequent to
treatment.
Hecht-Fleming Method—cont.
29 1 2 t h M a r c h 1 9 1 2 . . .
B. Naidu . . .
. . .
Negative . . .
. . .
. . .
. . .
30 15th " " . . . A.K., G.H. . . .
. . .
Negative . . .
. . .
. . .
. . .
31 15th " " . . .
G.H. . . .
Caneruum oris . . . Indefinite . . .
. . .
. . .
. . .
3 2 15th " " . . . K., G.H. . . .
. . .
Negative . . .
. . .
. . .
. . .
33 19th " " . . . G.H. . . .
Vide case 31 . . . Indefinite . . .
. . .
. . .
. . .
34 19th " " . . . V. Naidu G.H. . . .
Frimary sore 1½ years ago followed by rash,
sore throat and fever suffering from rupia
on chest. Soppurative glands in groins,
ulcers on leg nodes on clavicles, wrist and
ribs.
. . .
. . .
Salvarsan (21st
February 1912).
Negative . . .
Cured.
35 19th March 1912 . . . V., G.H. . . .
. . .
Indefinite . . .
. . .
. . .
. . .
36
Do. . . . Pte., H. Poonamallee . . .
. . .
Negative . . .
. . .
. . .
. . .
37 20th March 1912
. . . W., G.H. . . .
Vide case 12 . . .
. . .
. . .
Salvarsan (2nd Febru-
ary 1912.
Negative . . .
Cured.
38 21st March 1912 . . . Pte., S. Poonamallee . . .
. . .
Negative . . .
. . .
. . .
. . .
39
Do. . . . Pte., E. Poonamallee . . .
. . .
Indefinite . . .
. . .
. . .
. . .
40
Do. . . . Pte., S. Poonamallee . . .
. . .
Negative . . .
. . .
. . .
. . .
4 1 23rd March 1912 . . . F., G.H. . . .
. . .
Indefinite . . .
. . .
. . .
. . .
42
Do. . . . H., G.H. . . .
. . .
Positive . . . Strong . . .
. . .
. . .
43
Do. . . . A. G. Care of Major C.S. . . .
. . .
Negative . . .
. . .
. . .
. . .
44 25th March 1912 . . . M., Poonamallee . . .
. . .
Indefinite . . .
. . .
. . .
. . .
45
D o . . . .
L., Poonamallee . . .
. . .
Do. . . .
. . .
. . .
. . .
46
Do. . . . B., G.H. . . .
. . .
Do. . . .
. . .
. . .
. . .
47
Do. . . . V. Pillai, G.H. . . .
. . .
Negative . . .
. . .
. . .
. . .
48
Do. . . . P., G.H. . . .
. . .
D o . . . .
. . .
. . .
. . .
49
D o . . . .
V. Mudaly, G.H. . . .
Had a chancre of four months' duration.
White yellowish discharge from the
urethra. Buboes in both groins. Dark
pigmented patches on both palms Glands
enlarged.
Positive . . .
. . .
. . .
. . .
50
Do. . . . K., G.H. . . .
. . . Indefinite . . .
. . .
. . .
. . .
51
Do. . . . V., G.H. . . .
. . .
Do. . . .
. . .
. . .
. . .
52
Do. . . . V. Chetti, G.H. . . .
Chancre ten years ago. Lumpy painful
swelling appearing and disappearing on
his chest wall for the last two years. T wo
ulcers on the right side of the neck dis
-charging pus.
Positive . . .
. . .
. . .
. . .
53
Do. . . . G., G.H. . . .
. . .
Do. . . .
. . .
. . .
XX
TABLE VII— cont.
Number of blood examined.
History of cases.
Wassermann reaction
before treatment.
Treatment.
N u m b e r .
Date of
examination.
Name.
History.
Reaction.
Degree
of
reaction.
Treatment.
Reaction
subsequent to
treatment.
Remarks.
Hecht-Fleming Method—cont.
54 25th March 1912
C. Chetti, G.H. . . .
Sore on the penis four years ago. No history
of a rash or sore throat. Has a big
gummatous ulcer on the right tibia, not
healing in spite of treatment with
perchloride gauze and iodoform. Another
ulcer on the left leg just below the knee.
Positive . . .
. . .
. . .
. . .
55
D o . . . .
T., G.H. . . .
. . .
Negative . . .
. . .
. . .
. . .
56 26th March 1912 . . . J.S., G.H. . . .
Had hard and soft sores eight years ago
which apparently healed under mercury
treatment. For the last three years
occasional pain in the knee and hip.
Do. . . .
. . .
Mercury . . .
. . .
Cured.
57
Do. . .. O.K., G.H. . . .
Ulcers in the throat for six months. Rash
over the body three months ago. Glands
enlarged and shotty. The uvula is eaten
away and the tonsils partially. Un
-healthy edges, base covered with thick
slough.
Indefinite . . .
. . .
Mercury and Salver
-san (28th March
1912).
. . .
C u r e d .
J., G.H. . . .
5 8
Do. . . .
Had a boil near the anus a year ago which
was incised and healed up. Fever and
swelling on the right iliac region three
months ago sore throat a year ago. Two
sinuses over the right inguinal region
eondylomata about the anus.
Positive . . .
. . .
Salvarsan (28th March
1912).
. . .
59
Do. . . . R. B., G.H. . . .
Perforated palate.
Pillars
of fauces
ulcerated.
Negative . . .
. . .
D o . . . .
. . .
60 28th March 1912 . . . G.H. . . .
. . .
Do. . . .
. . .
. . .
. . .
61
Do. . . . D.R., G.H. . . .
Hard papule below the penis. Soft sore
discharging pus.Small red spots on his
body and a few on the anus a fortnight
ago. The rash disappeared in a week
after treated with mercury. Had slight
fever. The glands were enlarged and
shotty.
. . .
. . .
Mercury and Salvar
-san (27th March
1912).
Indefinite . . .
62
Do. . . . G.S., G.H. . . .
Denies history of syphilis. Pain in both the
ankles, left tibia 6 months ago. Subse
- q u e n t l y r i g h t k n e e s w o l l e n . A m o n t h
h e n c e a n o t h e r s w e l l i n g i n t h e m i d d l e o f
left tibia. A. small ulcer size of 2 anna
piece in front of sternum. Epitroch
-lear glands enlarged.
Positive . . . Trace (?) . . .
. . .
. . .
TABLE VII—cont.
Number of bloods examined.
History of eases.
Wassermann reaction
before treatment.
Treatment.
N u m b e r .
Date of
examination.
Name.
History.
Reaction.
Degree
of
reaction.
Treatment.
Reaction
subsequent to
treatment.
Remarks.
Hecht-Fleming Method— cont.
63 29th March 1912 . . . P., G. H. . . .
Six small sores on the penis 6 months ago
and a bubo in the left groin. Eruption
all over the body. Pain in joints and
sore throat. Glands enlarged. A few
mucous tubercles on the back of the
pharynx.
Positive . . .
. . .
. . .
. . .
64
Do. . . . Y., G.H. . . .
Ulcers in front of chest. Necrosis of bone.
History of sore two years ago).
. . .
. . .
Salvarsan 17th Nov-
ember 1911.
Negative.
65
Do. . . . R., G.H. . . .
. . . Indefinite . . .
. . .
. . .
. . .
66
Do. . . . S., G.H. . . .
. . .
Do. . . .
. . .
. . .
. . .
67
Do. . . . A., G.H. . . .
. . .
Do. . . .
. . .
. . .
. . .
68
Do. . . . V. G.H. . . .
. . .
Do. . . .
. . .
. . .
. . .
69
Do. . . . M., G.H. . . .
. . .
Do.. . .
. . .
. . .
. . .
70
Do. . . . S. G.H. . . .
. . .
Do. . . .
. . .
. . .
. . .
Original Method—Nagative.
71 3rd April 1912 . . . Pte. M., Poonamalle . . .
. . .
Do. . . .
. . .
. . .
. . .
72
Do. . . .
Do.
do. . . .
. . .
Negative. . . .
. . .
. . .
. . .
D o . . . .
73
Do. . . . Pte. R., Poonamallee . . .
. . .
Indefinite . . .
. . .
. . .
. . .
Do.
74
Do. . . . C. Mudaly, Lunatic Asylum . . .
. . .
Do. . . .
. . .
. . .
. . .
D o . .
75 6th April 1912 . . . P. G.H. . . . Infection 3 months ago. Ulcer on penis.
Condylomatus growth round the anus.
Epitrochlear glands enlarged.
Do. . . .
. . .
. . .
. . .
Positive.
76
Do. . . . P. N. P., G,H. . . . Chancre 6 years ago. Sore throat. Difficult
breathing. Tip of the nose thickened
and enlarged and. a few nodules. Nostril
ulcerated with foul discharge.
Positive
strong.
. . .
. . .
. . .
Do.
77
Do. . . . S . , G . H . . . . Chancre and bubo 2 years ago. Eruption
all over the body. Swelling in the right
leg discharging pus.
Indefinite . . .
. . .
. . .
. . .
'Positive trace.
78
Do. . . . S., G H. . . . Chancre 3½ y e a r s a g o .
S o r e t h r o a t , r a s h
all over the body and pain in all joints.
Gummatons ulcer on the right tibia.
Do. . . .
. . .
. . . .
. . . .
Positive strong.
Original M ethod.
7 9 10thApril 1912
. . . C. G.H. . . . Sore on the penis 3 years ago. Two months
later secondary eruptions, pain in all joints
and nodes in tibia. Responded to mercury
treatment but reappeared when medicine
was stopped. Swelling on the forehead
from one temple to the other. Pain all
over the head.
. . .
. . .
Mercury and Salvar-
san by
Captain
Chalmers, I.M.S.,
13th
December
1911.
Positive weak.
xxii
TABLE VII—cont.
Number of bloods examined.
History of cases.
Wassermann reaction
before treatment.
T r e a t m e n t .
Remarks.
N u m b e r .
Date of
examination.
Name.
History.
Reaction.
Degree
of
reaction.
Treatment.
Reaction
subsequent to
treatment.
Original Method - cont.
80 10th April 1912 . . . T., G.H. . . . Denies history of syphilis ; small ulcers on
the right leg discharging pus for the last
6 months.
Positive . . . Strong . . .
. . .
. . .
81
Do. . . . A.W.C., G.H. . . .
. . .
Negative . . .
. . .
. . .
. . .
82
Do. . . . P., G.H. . . . Syphilitic ulceration of the upper lip whic
had extended into the gum and hard
palate. One injection on 7th June 1911.
On the appearance of the ulcers again a
second injection given on 13th August
1911. Pain in the thigh, buttocks and
left knee joints. Conjunctivities of the
left eye. Dimness of vision from his
seventh year.
. . .
. . .
Salvarsan
—
(i) 7th June 1911.
(ii) 13th Aug. „
Positive weak.
83
D o . . . . G., G. H. . . .
. . .
Negative . . .
. . .
. . .
. . .
84 15th April 1912 . . . V., G.H. . . . A year ago had a discharge from the nose
and small eruptions on the nose which
spread around the lower half of the nose.
Septum of the nose ulcerated. Inguinal
glands enlarged.
Positive . . . Weak . . .
. . .
. . .
85
Do. . . . Miss G., G.H. . . . Four months ago rash on her head and face.
Patches on both knees and thighs.
Do. . . .
Do. . . .
. . .
. . .
86
Do. . . . K., G.H. . . . Ulcer in the mucous membrane of the upper
lip involving the gum two years ago. He
was cured and the disease recurred now
with a sore-throat and sneezing. White
patch in the right fauces and three or
four dark patches in the hard palate
Left epitrochlear glands enlarged.
Do. . . . Strong . . .
. . .
. . .
87
1 ) o . . . .
A., G. H. . . .
. . .
Negative . . .
. . .
. . .
88
. D o . . . .
Y., G. H. . . .
. . .
Po s i t i v e . . .
S t r o n g . . .
. . .
. . .
89
Do. . . .
R . , G . H . . . .
Infected with a wound . . .
. . .
. . .
Mercury and salvar-
san.
Negative.
90 18th April 1912 . . . H., G.H. . . .
. . . Negative . . .
. . .
. . .
. . .
91
Do. . . . I., G. H. . . .
. . .
Positive . . . Weak . . .
. . .
. . .
92
Do. . . . G.S., G.H. . . . Vide case 62 . . .
. . .
. . .
Salvarsan (3rd April
1912).
Positive strong.
93
Do. . . . V. Chetti, G.H. . . . vide case 52 . . .
. . .
. . .
Do.
Indefinite.
94
Do. . . . A.W.P., G.H. . . .
Do. 63 . . .
. . .
. . .
Do.
Positive strong.
95
Do. . . . C. Chetti, G.H. . . .
Do. 54 . . .
. . .
. . .
Do.
Negative.
x x i i i