RUTH GILBERT 845 



The Army and Navy laboratories' have specified the procedures to be used in these 

 departments, and methods followed in certain of the state laboratories have been 

 adopted by many of the local laboratories.' In 1920^ the United States Public Health 

 Service proposed a uniform complement fixation technique,^ and in 1922 the Society 

 of American Bacteriologists appointed a committee of five^ for the purpose of con- 

 sidering a standard procedure. The Committee on Standard Methods of the Ameri- 

 can Public Health Association in 1923 appointed a referee to consider methods for 

 the standardization of the test. Since 1924 a number of the large laboratories in the 

 United States have co-operated with this referee in a further study of the problem. 

 At first merely an outline^ for study was made on which forty-six representative 

 laboratories were asked to comment. ^ After the receipt of the various suggestions, it 

 was decided first to test^ representative antigens by the different procedures being 

 used routinely. The comparative tests that were made demonstrated that in general a 

 very sensitive cholesterinized antigen was essential for the detection of the reaction 

 in early and latent syphilis. Conclusions as to the "specificity" of such a sensitive 

 antigen varied, however, according to the method with which it was employed and 

 the nature and amount of the clinical material studied. The possibility was indicated, 

 moreover, that a less sensitive antigen might prove effective if other technical factors 

 were suitably adjusted. 



In view of these findings, it was proposed that further study should be directed 

 to the testing of each antigen under the conditions recommended as optimum for its 

 use. To this end, in 1926' portions of the same sera were tested, with the antigens and 

 technique routinely employed in eight large laboratories. The results of these tests 

 showed many marked variations, the greatest divergence occurring with specimens 

 from treated cases of syphilis. The most sensitive results were obtained with methods 



' At present a precipitation test is being used in the Navy. The Navy adopts the Kahn precipita- 

 tion test in place of the Wassermann {Mil. Surgeon, 58, 202. 1926). 



2 For the past ten years in New York State a satisfactory degree of uniformity has been secured 

 through the limitation of approval to laboratories prepared to perform a fairly large number of tests 

 and that are in charge of properly qualified persons, who submit a description of the technique they 

 plan to employ, agree to use two antigens, one of which is cholesterinized, and to control adequately 

 the test. They also demonstrate their ability to secure reasonably accurate results through the testing 

 of specimens submitted for comparative examination. See Wadsworth, A. B.: "Cooperation between 

 a Central State Laboratory and Local Municipal and County Laboratories," J. A.M. A., 77, 512. 192 1. 



3 Gumming, H. S.: Surgeon General — Venereal Disease Division, U.S. Pub. Health Service, Circ. 

 Letter 448. August 12, 1920. 



■» Neill, M. H.: The Complement-Fixation Test for Syphilis, U.S. Pub. Health Rep., No. 483. 1918. 



5 Personal communication from Col. Craig to Dr. Wadsworth, as a member of the Committee 

 for Standardization of the Wassermann Reaction, appointed by the Society of American Bacteriolo- 

 gists. 



^ Gilbert, R., and Langworthy, V.: "Standardization of the Wassermann Test," Am. J. Pub. 

 Health, 15, 201. 1925. 



' Gilbert, R., and Langworthy, V.: "Standardization of the Wassermann Test," ibid., p. 323. 

 1925- 



8 Gilbert, R., and Langworthy, V.: "Standardization of the Wassermann Test," Am. J. Syph., 

 10, loi. 1926. 



» Gilbert, R., and Langworthy, V.: ibid., u, 475. 1927. 



