COMPLEMENT-FIXATION TEST IN TUBERCULOSIS 517 



The antigen is prepared of numerous strains of typhoid bacilli the 

 more the better. Cultures are grown on slants of agar for forty-eight 

 hours, washed off with small quantities of sterile distilled water, heated 

 to 60 C. for two hours, shaken mechanically for twenty-four hours, and 

 either filtered through a sterile Berkefeld filter or thoroughly centrif- 

 ugalized. The filtrate is preserved with 0.5 per cent, phenol and used 

 as antigen. 



I have secured good results by removing the growths with small 

 amounts of normal salt solution, and placing them in a shaking flask, 

 and shaking for an hour to break up the clumps. After heating to 60 C. 

 for an hour, 1 per cent, glycerin and 0.5 phenol are added as preservatives, 

 and the mixture stored away in ampules containing 1 c.c. each. The 

 emulsion should be slightly milky in appearance. 



The antigen is diluted 1 : 10 or 1 : 20, and the anticomplementary 

 dose determined by titration before the main tests are conducted. The 

 technic of the reaction is exactly similar to the gonococcus fixation test. 



The ease with which the Widal reaction is performed renders it the 

 method of choice. Nevertheless the complement-fixation test is quite 

 delicate, and will frequently aid, where the agglutination test is negative 

 or absent and in making the differential diagnosis from paratyphoid 

 fever. The strongest reactions are secured late in the disease. 



COMPLEMENT-FIXATION TEST IN TUBERCULOSIS 

 It was the original studies in complement fixation in tuberculosis 

 made by Wassermann and Bruch that later induced these workers, in 

 cooperation with Neisser, to apply the method to the diagnosis of syphilis. 

 The first application of complement-fixation in tuberculosis was 

 made by Widal and LeSourd 1 in 1901. They obtained deviation of 

 complement in certain cases of tuberculosis, using as antigen homoge- 

 neous emulsions of tubercle bacilli of the Arloing-Courmont strain. In 

 1903 Bordet and Gengou 2 demonstrated the presence of antibody 

 capable of uniting with tubercle bacilli and fixing complement in the 

 sera of tuberculous animals. Wassermann and Bruck 3 in 1906 demon- 

 strated the presence of an antibody to tuberculin in patients treated 

 with tuberculin, but they examined only 13 cases of pulmonary tuber- 

 culosis. Caulfield 4 in 1911 examined 104 cases of pulmonary tubercu- 



1 Cited by Sherman and Miller, Edinburgh Med. Jour., 1913, 10, 81. 



2 Compt. rend. Acad. de Sc., 1903, 137, 351. 



3 Deutsch. med. Wchnschr., 1906, 32, 449. 



4 Jour. Med. Research, 1911, 24, 122. 



