RUTH GILBERT 847 



with a serum known to give complete fixation. There should be careful adjustment 

 of the hemolytic system, and the temperature and time for fixation should be uniform. 



What has been said relative to tests on blood serum applies equally well to spinal 

 fluid. If the fluid has been freshly collected, however, it does not need to be inacti- 

 vated unless blood is present. The use of from two to ten times as much spinal fluid 

 as serum is recommended. The reactions of other body fluids have apparently not 

 been extensively studied, but there is no indication that transudates free from bacteria 

 used in properly controlled tests will react, if the patients from whom they are ob- 

 tained are not syphilitic. 



Klauder and Kolmer^ have tested dilutions of fluid removed from chancres and 

 report that fLxation is often secured before a reaction can be obtained with serum from 

 the patient. As such material is badly contaminated, it is not satisfactory for sub- 

 mission to a laboratory located at a distance. 



The interpretation of the results obtained in the complement fixation test for 

 syphilis of necessity varies, depending on the technique employed and the care with 

 which the test is performed. There are reports of definite fixation occurring with 

 serum from cases of pregnancy and from patients suffering from various diseases in- 

 cluding scarlet fever, pellagra, diabetes, tuberculosis, leprosy, malaria, relapsing fever, 

 and yaws. As regards yaws, which is due to Treponema pertenue, an organism almost 

 indistinguishable from Treponema pallidum, the literature indicates that a reaction 

 can be expected with equal regularity as in the case of syphilis. There seems to be an 

 indication also that in rare instances reactions may be secured with blood from cases 

 of malaria, leprosy, and tuberculosis, even when syphilis is not present, but there is 

 little evidence that in the other conditions mentioned there is any likelihood of re- 

 actions occurring when syphilis can be ruled out with reasonable certainty. It is not 

 considered desirable to secure specimens of blood when the patient has a fever or is 

 under the influence of alcohol or an anesthetic. Since the test is based on a reaction 

 with a non-specific antigen, it is of course necessary to interpret all reactions in the 

 light of the clinical evidence. If, however, definite fixation is obtained in properly 

 controlled tests, there is strong presumptive evidence of syphilis. The interpretation 

 of partial reactions depends largely on the sensitiveness of the test, but in general 

 should not be considered significant unless there is a history or clinical evidence that 

 the case is one of syphilis. The failure to obtain fixation does not rule out the disease. 

 A reaction is not regularly obtained until from four to six weeks or even longer after 

 the appearance of the lesion and not infrequently specimens from cases of tertiary 

 or latent syphilis fail to react. 



In spite of the great variation in the technique used and the many sources of 

 inaccuracy, the complement fixation test for syphflis furnishes information that in the 

 great majority of cases is so in accord with the clinical manifestations that the test 

 is being used more and more generally throughout the world. In fact, there seems to 

 be no other laboratory test that furnishes more valuable information for the clinician. 



^Klauder, J. V., and Kolmer, J. A.: "The Wassermann Test Performed with Chancre Fluid 

 as an Aid to the Early Diagnosis of Syphilis," Arch. Dermal. b° Syph., s, 566. 1922. 



