252 MEDICAL BACTERIOLOGY 



soluble-acetone insoluble or acetone soluble or cholesterinized antigen or the 

 reverse, so in doubtful cases repetition of the test with these different antigens 

 may distinguish its true nature. 



The employment of two units of hemolytic amboceptor is necessary in rou- 

 tine complement fixation to avoid error from non-specific deviation of comple- 

 ment. When a doubtful reaction is obtained if the test is repeated using only 

 one unit of hemolytic amboceptor, after a preliminary examination of the sus- 

 pected serum for non-specific complement deviation properties, a decided posi- 

 tive reaction is frequently obtained. 



I have carefully studied this phase of the subject and believe accuracy is 

 more nearly realized and the interests of patients best served by adhering to the 

 following rule when the Wassermann reaction is doubtful: 



If the patient has previously had unquestionable history, physical signs or 

 serum reaction of syphilis, consider it positive. 



If the patient's history contraindicated syphilis and there are no positive 

 clinical evidences of the disease, eliminate the possibility of the reaction having 

 been masked by mercury or arsenic, or alcohol, give provocative treatment, ob- 

 tain both blood and spinal fluid and examine both, using salt solution fetal liver 

 extract, alcoholic extract and ether soluble-acetone insoluble antigens and two 

 units of hemolytic amboceptor. If under these conditions more than half of the 

 cells are hemolized in the tube containing o.i cc. of patient's serum and one unit 

 of complement, and there is complete hemolysis in the tube containing two units 

 of complement reserve diagnosis and institute salvarsan treatment if this 

 does not alter the reaction, consider it negative. 



It is the consensus of opinion that the Wassermann test is one of the greatest 

 factors in medical diagnosis. Sporadically, prominent men attempt to belittle 

 its value. He who will trouble to investigate will soon learn that the great 

 majority of congenital syphilitics, unrecognized as such by physical examina- 

 tion are properly diagnosticated by this test; that in cases of doubtful nature, 

 which if syphilitic are in the tertiary stage, the diagnosis without the Wasser- 

 mann test is as often wrong as right, and with it the error is reduced one- 

 half. These are not its greatest merits, but suffice to make it an indispensable 

 part of every conscientious physician's armamentarium. 



FURTHER CONSIDERATION OF THE WASSERMANN TEST 



In the development of -the complement fixation test for syphilis, Wassermann 

 and his co-workers investigated each factor entering into it and the mechanism 

 of reaction more thoroughly than any of their followers. In his original com- 

 munication he states there is a fundamental reason for each step in the technique 

 he describes and this has been amply proven. 



Before the profession, at large knew of the test several modifications were 

 introduced by as many different experimenters. So many modifications have 

 been recommended that it would require a large volume to tabulate them. The 

 numerous modifications have one feature in common, namely, they have all 

 failed to stand the test of time. Each has had its enthusiastic advocates but 



