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DEAR DR. ROACH: I read that in the 1700s, animal blood was transfused into humans to cure syphilis. Is this true? -- T.U.

ANSWER: The story is a bit more complicated. Transfusion from animals into humans was certainly done, with published reports dating from 1667, sometimes to treat fever and sometimes purely for scientific knowledge with paid volunteers. Unfortunately, due to the high death rates, the practice was abandoned until the 1800s, when it was "rediscovered" and tried again but still had high death rates.

Transfusion of animal blood into humans leads to transfusion reactions as the recipient destroys the foreign material, which the body treats as an invader (like cancer or an infection). A transfusion reaction is usually associated with fever and other symptoms. Animal transfusion was abandoned after the discovery of blood group types and the availability of safe human-to-human transfusion.

The issue with syphilis has to do with fever. It had been known since ancient times that fever sometimes had a temporary beneficial effect on chronic infections and other medical conditions. Austrian psychiatrist Julius Wagner-Jauregg won the Nobel Prize in Physiology or Medicine in 1927 for the use of fever to treat neurosyphilis. Although he tried many ways to induce fever, he settled on deliberately infecting patients with malaria.

He reported that 50 out of more than 200 patients treated with this recovered enough to return to work, and subsequent studies showed about 25% of people who had "full remission" of their symptoms, 25% with "partial remission," and 50% with no improvement or death. If a patient improved, the malaria would later be treated with quinine.

I do want to emphasize that I doubt these were cures; it's very difficult to cure late-stage syphilis, and I suspect that those who went into remission would have relapsed. In 1943, penicillin was found to cure syphilis, and penicillin remains the only proven cure for late-stage syphilis of the brain. This put an end to fever therapy for syphilis.

It is possible that animal blood was used deliberately to provoke the fever from transfusion reactions, but the only case I found in history that might support this was in 1667, in a patient who was thought to possibly have syphilis. Although he was reported to have improved for two months, he subsequently died just before a second transfusion attempt and was found after the trial to have been poisoned by his wife with arsenic.

DEAR DR. ROACH: In a recent column, a reader mentioned going to an optometrist for vision issues, but I always see an ophthalmologist. -- P.A.

ANSWER: An optometrist is an excellent choice for a routine eye exam, for getting prescriptions for glasses or contact lenses, and for help with common eye concerns like dry eye. They are good at identifying eye diseases like cataracts and glaucoma and, in most states, can prescribe medication for glaucoma. An optometrist knows when to refer patients to an ophthalmologist, like with complex cases, when initial treatment is ineffective, or when surgery might be indicated.

Patients with diabetes or known eye disease should be seeing an ophthalmologist, as should people with new vision changes or eye pain.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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