Gold-testing in gold treatment of chronic polyarthritis; results of continued experiments.

Method We use aurothion dilutions of 1: 1, 1: 3, 1: 5, and 1: 10, and, for purposes of control, the same dilutions of 65 per cent. sodium thiosulphate solution.* With a die in the shape of a thin circle with an interior diameter of 5 mm., eight circles are stamped on the skin of one shoulder, four in an upper and four in a lower row, for the aurothion and the sodium thiosulphate, respectively. Into these circles are injected intracutaneously sufficient amounts of each dilution to produce a papule that fills the circle to the inner margin. This requires roughly 0 03 ml. To obtain a papule that fits into the circle outlined, the point of the needle should be inserted somewhat eccentrically into the circle. The readings are taken after 20 to 30 min. An oedematous papule of from 5 x 5 to 10 x 10 mm. with a greater or lesser reddened marginal zone is recorded as (+), a papule of from 10x10 to 5lx15 mm. as +, and a papule of from 15 x 15 to 20 x 20 mm. as + +, in accordance with the marking system generally used in the diagnosis of allergies. The reading is recorded with regard to the size of the control papule. If, for example, this latter is (+) and the aurothion papule is +, the reaction is recorded as (+). All recent admissions to the department have been tested, and tests are repeated fortnightly on patients receiving gold salt injections. Gold therapy is not instituted until the testing has been carried out. The reactions frequently vary as the tests are repeated. The reactions may to the same dilutions become either stronger or weaker; a positive reaction may appear with a weaker dilution than previously, or may disappear with the weaker dilutions. In some cases the reactions are unchanged. The purpose of the present method is to establish a difference between the incidence of complications in those cases that show increasing sensitivity and those that show decreasing sensitivity during the course of the treatment. On the basis of this one would be able to preclude complications by varying or withdrawing the gold treatment.