Experiments in gold-testing in gold treatment of polyarthritis.

Gold salts are still the best of all the therapeutic agents used in the treatment of chronic polyarthritis. Complications of varying degrees of severity are encountered in about 50 per cent. of the cases so treated. A mild complication, however, usually causes the patient only slight discomfort, particularly as most often his rheumatic distress simultaneously undergoes rapid alleviation for a shorter or longer period. Nevertheless, in certain cases a serious, occasionally very painful, diseased condition develops which proves far worse than the distress for which the patient in question sought medical aid. As a result gold-treatment has not won the popularity it deserves, a circumstance which the good results obtained with BAL do not yet seem to have altered. A negative attitude to gold therapy is also natural in those cases in which complications arise some time after the patient's discharge. Many such cases ignore their symptoms as long as possible, not understanding their seriousness, with the result that a long period elapses before their distress can be alleviated by expert care. Inasmuch as there is no way of foreseeing such a development after gold therapy, an element of uncertainty is involved, disagreeable to both physician and patient. There is much to indicate that these cases arise from a straightforward allergy to the gold salt used. Thus it should be possible to ascertain by a test which patients are hypersensitive to gold and thus likely to suffer such complications. In the relatively scanty literature on these problems, dermatitis has attracted particular attention. Lichtenstein and Stillians (1935) used a patch test with 33 per cent. gold sodium thiosulphate in wool fat. They obtained positive reactions in over one hundred cases, all of which had a rash during gold treatment. In addition, they obtained positive reactions in 40 per cent. of the total number of cases treated with gold sodium thiosulphate, in 25 per cent. of which dermatitis developed. They do not, however, state whether the tests were performed before, during, or after the gold therapy, or whether a positive reaction indicated a complication which set in later. Schwatt and Rest (1937) used an ointment consisting of one part sanocrysin to two parts lanolin with negative results. Some investigators have attempted intracutaneous testing with gold salts (Lebeuf (1932) and Gate, Cuilleret, and Tiran (1932), among others), but these report limited experimental series, with only a few tests in each case, and with …