Comparative value of the Weltmann serocoagulation reaction and the sedimentation rate (Cutler) in determining activity of the rheumatic process.

Abstract

Abstract 1.1. The Weltmann serocoagulation reaction proved to be a laboratory adjunct of considerable value in the prediction of rheumatic activity in a large group of naval patients hospitalized with rheumatic fever. 2.2. Of a total of 2,552 observations upon 400 patients with or convalescent from rheumatic fever, the Weltmann reaction correlated with the clinical status 97.2 per cent of the time against a correlation of 86.6 per cent for the Cutler sedimentation rate. 3.3. In 46 patients who exhibited rheumatic activity during the study, the Weltmann reaction correlated with the clinical status 93 per cent of the time against a Cutler sedimentation rate correlation of 90 per cent of the time during periods of activity. The respective correlations during periods of inactivity on these patients were 99 per cent for the Weltmann and 93 per cent for the sedimentation rate. 4.4. Of a total of 1,857 observations upon 350 patients who exhibited no rheumatic activity during the course of study, the Weltmann correlated 98.1 per cent of the time and the sedimentation rate 85.9 per cent of the time with the clinical observations. When the 22 patients who had four or more abnormal sedimentation rates were excluded, the Cutler sedimentation rate correlation was raised to 92.2 per cent. 5.5. Certain patients contributed more than their share of errors and were significantly important in the greater percentage of discrepancies which occurred in the sedimentation rate. These patients were those who failed to show expected increases of the sedimentation rate during periods of activity, and second, those who exhibited persistently elevated sedimentation rates following the cessation of activity. Similar persistent discrepancies between the Weltmann reaction and the clinical course of the patient were not observed. 6.6. The Weltmann reaction is of particular value as a complementary test to the sedimentation rate in the handling of large numbers of rheumatic patients where the physician must depend on laboratory evidences of rheumatic activity to a large extent in the management of patients under his care. It is also of particular value where discrepancies between the sedimentation rate and the clinical course leave him undecided as to the state of activity of the rheumatic process in his patient.