432 IMMUNOLOGY 



"9. There is no serological procedure at present available, nor 

 is it probable that one will ever be devised, with which a false 

 negative reaction may not be obtained. 



"10. The simultaneous use of both complement fixation and 

 precipitation tests on every serum should be practiced routinely." 



This paper by Kilduffe (1933) as well as the reports of Denison 

 and McDonald (1933), Heathman and Higginbotham (1932) and 

 Nigg and Larsen (1928), previously mentioned, as well as many 

 others indicate that there is a growing appreciation of the value 

 of the Kolmer-Wassennann complement fixation technique and of 

 tlie need for a standardized procedure that will undoubtedly in- 

 clude some form of flocculation test a.s a check on the former. 



The Provocative Wassermann Reaction. — The Effect of 

 Treatment on the Reagin Content of the Blood. An excellent 

 discussion of the provocative Wassermann reaction is given in a 

 paper by Belding (1929). He says that Gennerich (1910) and 

 Milian (1910) reported, almost simultaneously, that in a certain 

 percentage of syphilitics with negative blood Wassermanns, the 

 complement fixation becomes positive following a single injection 

 of arsphenamine. Others have reported various drugs as well 

 as foreign protein as apparently producing provocative reactions. 

 The average dose of arsphenamine recommended is apparently 0.3 

 Gm. Belding says that a few investigators believe that the phenom- 

 enon called a ''provocative Wassermann reaction" is a myth. They 

 explain the positive results as due either to errors in laboratory 

 technique or to a coincidence in the occurrence of reagin follow- 

 ing the injection of a drug or foreign protein. While Belding con- 

 cludes that the majority of provocative reactions reported in the 

 literature may be "ascribed to technical error" he reports that 3.3 

 per cent of 338 patients under treatment for syphilis .showed an 

 increase in reagin content of the blood following the first treatment. 

 He regards the test as of doubtful value because of the many possi- 

 bilities of error. 



Wassermann-Fast Cases. — An excellent discussion of Wasser- 

 mann-fast syphilis is given in a paper by Tobias (1928). He says 

 that the term includes both those cases that are apparently refrac- 

 tory to treatment as indicated by the persistence of symptoms and a 

 positive Wassermann, and second, cases that become, after adequate 

 treatment, free of all symptoms except a positive blood Wasser- 



