320 Wassermann Reaction for Diagnosis of Syphilis 



scarcely began to meet with practical application, however, 

 before it was discovered that the active antigenic substance 

 was soluble in alcohol, was present in other than syphilitic 

 livers, and could be extracted not only from human tissues, 

 but also from dogs' livers and from guinea-pigs' hearts. 

 Forges and Meier, indeed, found that lecithin could play the 

 role of syphilitic antigen, and Leviditi and Yamanonchi 

 place sodium glycocholate, sodium taurocholate, protogon, 

 and cholin among those bodies capable of acting as syphilitic 

 antigens, and Noguchi goes so far from the original that he 

 regularly employs an extract of the normal guinea-pig's heart 

 as the antigen to be employed in his modification of the test. 



These discoveries now make it clear that the complement 

 fixation that takes place in syphilis is not identical with that 

 of the Bordet-Gengou reaction, in which it had its beginning. 

 Happily, however, the error does not destroy the usefulness 

 of the method for diagnosis. 



The probable nature of the reaction will be described below. 

 For the present we must be content to follow the beaten path, 

 and for this purpose will use the congenitally syphilitic liver 

 extract as the antigen, preparing it as described above. 



(2) The. Serum to be Tested. Wassermann, Neisser, and 

 Bruck at first employed the cerebrospinal fluid, but now the 

 blood-serum of the suspected patient is almost universally 

 used. As is usual with antibodies, the substances engaging 

 in the complement-fixation test are widely distributed 

 throughout the body, and reach the cerebrospinal fluid, the 

 milk, the urine, and the other body fluids through the blood, 

 in which it exists in greatest concentration. The blood is, 

 moreover, readily obtainable for study, which is another 

 reason it is at present used for making the test under all 

 ordinary circumstances. Some workers who, like Noguchi, 

 work with very small quantities of the reagents, secure 

 the blood by obstructing the venous circulation of the 

 thumb or of a finger by means of a rubber band (see di- 

 rections for obtaining the blood for making the opsonic 

 index), but the greater number prefer to obtain it by in- 

 troducing a large hypodermic needle into one of the veins 

 near the bend of the elbow. The arm above the elbow 

 is compressed by a fillet, as though for the purpose of 

 performing phlebotomy, and a conspicuous vein selected 

 for the purpose. The skin is first carefully washed, then 

 treated with tincture of iodin. If the patient is nervous, a 



