| Clinical diagnosis | Frequency, per cent. | Remarks |
| Cerebro-spinal lues | 85-90 | Counts often over 100—may reach 1000 per c.mm. |
| Tabes dorsalis | 90 | Counts usually under 100. |
| General paresis | 98 | Counts average 30-60 cells per c.mm. |
| Secondary lues | 30-40 | Moderate increase as a rule. |
| Multiple sclerosis | 25 | Border-line counts. |
| Cerebral haemorrhage | { Frequency | |
| Cerebral tumors | { is | Cellular increase is apt to be a very moderate one. |
| Sinus thrombosis | { variable | |
Globulin Increase Tests.—Noguchi’s butyric acid test is very satisfactory, but because of the objectionable odor of the butyric acid, we use the Ross-Jones and Pandy tests routinely in our laboratory.
For the Ross-Jones method, one cc. of saturated solution of ammonium sulphate is placed in a small test tube and one cc. of spinal fluid placed on top of this column. If globulin increase is present a turbid ring appears within a few seconds at the junction. Normally there is no sign of a ring. This test is a modification of Nonne’s Phase 1 reaction. For Pandy’s test, prepare a saturated solution of carbolic acid crystals in distilled water. Place 1 cc. of this reagent in a small test-tube and add 1 drop of spinal fluid. In a normal fluid, only the faintest opalescence is observed; but in a fluid with globulin increase a smoke-like white cloud develops instantly where the drop comes in contact with the reagent.
Colloidal Gold Test (Lange’s).—It is now generally accepted that this test is more diagnostic of general paresis than any other single test. The color changes in the first five tubes (1-10 : 1-160) are so constant that the term “paretic curve” is applied to such findings. Of less diagnostic value are the so-called cerebro-spinal lues curves where the color changes, though of less intensity than the paretic ones, are most marked in the third, fourth, fifth and sixth tubes (1-40 to 1-320). In various types of meningitis, other than luetic, the color changes are at times more marked in the tubes with the higher dilutions of spinal fluids (from 1-320 to 1-2560).
The paretic curve of the colloidal gold test generally runs parallel with a spinal fluid Wassermann and globulin increase. This agreement does not exist at all constantly for positive blood serum Wassermann tests and increased cell counts.
It may be stated that this test is of more importance in paresis than any single one of the four reactions of Nonne, viz.: (a) blood serum Wassermann; (b) spinal fluid Wasserman; (c) globulin increase, and (d) increased cell count of spinal fluid (pleocytosis). Of course, all of these tests should be carried out.
Test.—The test is carried out by preparing a series of ten test tubes containing dilutions of spinal fluid in 1 cc. of normal saline, ranging from 1-10 to 1-5120, and adding 5 cc. of the colloidal gold reagent to each tube and to a control tube containing salt solution alone. The successful application of the test is dependent upon (a) care in the preparation of the reagent; (b) absolute cleanliness of all glassware used, and, (c) on the entire absence of blood from the spinal fluid. Before using a new colloidal gold solution, it should be tested with spinal fluid of known reaction, so that it may be discarded if too sensitive or not sufficiently so. The color changes usually start almost immediately and if there is no change evident in half an hour, there will probably be none later. The maximum change occurs after several hours, so that readings are made after the tubes have stood overnight at room temperature. The proper color of the control in tube 11 should be salmon-red or old rose and the fluid should be perfectly transparent. When the color is changed in tubes containing dilutions of the spinal fluid we record one showing a bluish tint as 1. When the change is to a lilac we record it as 2. A distinct blue is marked as 3 and a pale blue as 4. When decolorization is complete there is the highest color change, which is noted as 5.
Mastic Test.—The mastic test as devised by Cutting is apparently of value as an aid in the diagnosis of syphilis of the nervous system. The test is made by treating six dilutions of spinal fluid in test tubes with an alcoholic extract of pure gum mastic, diluted with distilled water before using. Its great value lies in the ease of preparation from an effective gum mastic, and in the keeping qualities of the stock alcoholic extract. After standing at room temperature for twelve to eighteen hours or at 37°C., for six to twelve hours, readings are made. In positive cases (paresis) the mastic will be precipitated in the first one, two, three or four tubes (higher in strongly positive cases) leaving the supernatant fluid clear, with the mastic as a white flocculent precipitate at the bottom of the tube. In some positive reactions the opalescence of the fluid persists with a fine white precipitate at the bottom. The control tube must remain unchanged.
Showing the Average Frequency of the Various Reactions in Syphilis Of The Central Nervous System (Miller)