WASSERMANN AND OTHER COMPLEMENT FIXATION TESTS 255 



quantity of antigen inoculated, the greater the number and virulence of infective 

 organisms, the greater the antibody production. Exceptions to this rule are 

 numerous, especially and conspicuously so in syphilis. Any complement fixation 

 test can be made quantitative as well as qualitative. Quantitative Wasser- 

 mann tests are commonly made, usually four or five different degrees being dis- 

 tinguished; twenty or thirty different degrees instead of five might quite as well 

 be recognized. The quantitative determination is made by adding different 

 amounts of the patient's serum to a fixed amount of complement or different 

 amounts of complement to a fixed amount of serum. 



The majority of syphilitic individuals have sufficient amboceptors in o.i cc. 

 of their serum to fix all the complement in the same amount of guinea-pig serum; 

 many have more and some less. Citron recognized this fact early in the history 

 of the test. The possibility of making the Wassermann test more sensitive by 

 modifying the original technique and that given in previous chapters has been 

 described also the accompanying danger of obtaining pseudopositive reac- 

 tions. If one believes it best to so conduct the test that a positive reaction 

 will never be obtained with a non-syphilitic patient's serum, the quantitative 

 determination is limited to distinguishing between sera containing slightly 

 less than the average amount of specific amboceptors and those containing two, 

 three or four times as much, or more. 



It must be obvious to anyone familiar with the nature of the Wassermann 

 test that an accurate quantitative reaction can only be obtained after a prelimi- 

 nary determination of non-specific complement deviation and compensation for 

 same; this is practically never done in routine work it cannot be and therefore 

 routine quantitative determinations are nothing more than rough estimates, 

 indicating that the reaction is strong or weak as compared to the average reac- 

 tion. It is desirable to recognize whether a reaction is weak or strong before 

 treatment is instituted so that future tests will show whether the treatment 

 has been effective or not, but this is of little real value because experience has 

 shown that no treatment is permanently effective that does not cause a complete 

 disappearance of specific amboceptors and hence a clear-cut negative reaction. 

 I believe the practice of reporting reactions as + , ++, + + + , + + + + , is- 

 bad; it is implying a difference which is demonstrable serologically but not other- 

 wise and it has led to a very general and totally erroneous opinion among phy- 

 sicians that there is a different pathological, therapeutic and prognostic signifi- 

 cance according to the strength or weakness of the reaction. The Wassermann 

 test, clinical and postmortem findings are in perfect harmony in showing that 

 syphilis requires the most intensive treatment possible, medication to the 

 patient's limit of toleration, whether the reaction be + or + + + + + ; that it is 

 frequently just as difficult, sometimes more difficult, to change a -j- to , as to 

 change a + + + + + to ; that among the virulent cases that fail to respond 

 to treatment and terminate fatally, many show a -f- or + + throughout the 

 disease and not a + + + + . 



There, has been occasional mention in the literature of " Wassermann-fast " 

 cases, patients having contracted syphilis and developed syphilitic antibodies 



