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THE VALUE OF ABSORPTION METHODS IN THE WASSERMANN TEST

THE VALUE OF ABSORPTION METHODS IN THE WASSERMANN TEST THE VALUE OF ABSORPTION METHODS IN THE WASSERMANN TEST* C. H. M.D. BAILEY, NEW YORK is a It conceded most observers that in with by working hemolytic it is advisable to use known amounts of and cells. both system amboceptor Wassermann's method for the of makes use original diagnosis syphilis of of a 5 of with twice c.c. cent. per suspension corpuscles sheep just amount to the of these cells. Since the amboceptor necessary hemolyze of the existence an human of in some discovery antisheep amboceptor it a serums has been whether this additional amount of ambo- question not be sufficient to in with ceptor might produce hemolysis conjunction small residue of not first fixed in the of the reaction. complement stage If this should occur results would thus be obtained in negative syphilitic cases. The of this has rise to several modifi- recognition possibility given cations of the Wassermann reaction. The best-known of these is probably that of He maintained1 that "Wassermann's method Noguchi. original to is from an error the in human serum of a subject arising presence amount of natural of reactivated varying amboceptor capable being by He found that four units of complement." guinea-pig's experimentally the detection of one unit of antisheep prevent amboceptor entirely syphi- litic The modification of the Wassermann technic devised antibody. by him other that of this the has, advantages, among avoiding danger by use of a of human blood cells and the hemolytic serum system consisting of rabbit immunized them. against Several other methods of this source of error have been obviating which still make use of in suggested as the sheep corpuscles original Wassermann method. That of in which each serum is tested for Bauer,2 and artificial immune added serum to those antisheep amboceptor only which show an insufficient amount of natural to antisheep amboceptor the amounts with of cells and give complete hemolysis sheep complement used in the Wassermann will of course be efficient in those cases reaction, in which the human contains serum to just enough amboceptor give some serums contain complete hemolysis. times this As, however, many natural amount of with these the error source of still remains. amboceptor, of *From the St. Luke's F. C. Pathological Department Hospital, Wood, M.D., Director. 1. Jour. Noguchi: Exper. Med., 1909, xi, 392. Bauer: 429. 2. Sem. 1908, med., xxviii, Downloaded From: http://archinte.jamanetwork.com/ by a University of Edinburgh Library User on 06/21/2015 THE ARCHIVES OF INTERNAL MEDICINE Jacobaeus3 the from human proposed absorbing sheep amboceptor the addition of cells 37 C. serum the after at serum, by incubating sheep for one-half then off the cells and with hour; centrifuging proceeding to a the Wassermann reaction the technic. In series according regular cent, of 257 cases he obtained about 10 more this method per positives by than without He asserts that is also removed absorption. complementoid this a modification introduced thus it the of by method, giving advantage is Wechselmann4 in which removed the complementoid by by digesting inactivated human serum with barium Bauer5 had sulphate. previously tried the which Jacobaeus but discarded it on same procedure employed, account of its He declared that this the serum making antihemolytic. liver was much increased the addition of thus extract, property by causing to serums reactions. negative give positive in a S. this method series of obtained Mintz,8 cases, using thirty-eight reactions without The against twenty-five absorption. thirty positive serums were which reacted all syphilitic. positively 305 serums I have tried this method of on absorption amboceptor amount of natural of the The regardless antisheep amboceptor present. results of reaction on of these has been the Wassermann each serums with the result of the reaction the same serum with the on compared natural antisheep amboceptor present. of the contained one or more units of serums Only fifty-three 0.2 natural in that sufficient to c.c, antisheep amboceptor is, hemolyze in 1 c.c. of a 5 cent, of the completely per suspension sheep corpuscles serums was no of one unit of In there presence complement. seventy trace in 0.2 c.c. In of the remaining 182, antisheep antisheep amboceptor com¬ but in a not sufficient to was quantity produce amboceptor present, hemolysis. plete to technic the from the The remove employed antisheep amboceptor 0.5 human was as follows: To c.c. of the after serum serum, patient's 2 c.c. 0.85 cent, 0.1 was added of salt solution and c.c. inactivation, per incubated at 37 for of cells. After the mixture was C. sheep shaking, and the minutes. The cells were then off centrifuged twenty supernatant 0.5 c.c. of the diluted serum fluid used in the Wassermann reaction, used in the tube with and c.c. in the control tube without antigen being the amount of etc., antigen, complement, being correspondingly antigen, to The remainder of reduced one-half the usual the fluid was quantity. used to test the of the In about completeness amboceptor absorption. 3. Jacobaeus: Ztschr. f. Immunit\l=a"\tsforschung,Orig., 1911, viii, Ztschr. f. 1909, 524. 4. Wechselmann: Immunit\l=a"\tsforschung, iii, 5. klin. 1908, Bauer: Berl. Wchnschr., xiv, 6. Mintz: Ztschr. f. 1911, S. Immunit\l=a"\tsforschung, ix, Downloaded From: http://archinte.jamanetwork.com/ by a University of Edinburgh Library User on 06/21/2015 C. H. BAILEY 553 amount of the cases a sufficient of the serum was one-quarter patient's to test a used for in full cubic centimeter. remaining antisheep amboceptor In all but three of the 305 removal of the serums, amboceptor sheep was In each of these 0.2 c.c. showed a faint of trace complete. hemolytic for cells still One additional serum showed power sheep present. very was in a full cubic centimeter but none slight hemolytic remaining power 0.2 demonstrated in c.c. So far the removal from human serum is as of antisheep amboceptor conclude method is efficient. we that the concerned, always may practically The to the method is that bodies are in some way objection inhibitory this which con¬ produced by ("Sachs-Friedberger phenomenon") process at slow there sometimes trace of inhibition siderably hemolysis, being the end of an hour in the control tubes and in serums. The negative difference in between and serums reaction however, positive negative is, to the action not marked render the clear-cut, inhibitory being sufficiently method of which be due as a means error impracticable avoiding may any to the of natural antisheep amboceptor. presence asserts at 0 as Rossi7 that incubation C. for minutes is efficient twenty at 37 in the as incubation while this method absorbing amboceptor C, by not 0.5 the does His method is to add c.c. inhibitory phenomenon appear. to 1.5 of red blood c.c. of the both serum, sheep corpuscles patient's having to 0 been cooled C. This mixture is at this previously kept temperature to for from then and the twenty thirty minutes, rapidly centrifuged, a a serum drawn off with In series of cases Rossi pipette. sixty syphilitic Wassermann and obtained the reaction fifty-six positives fifty positives by after absorption. as as at 37 195 This method of well that was tried on C, absorption, a of Rossi technic was of the above 305 serums. In these the portion followed in detail. With the remainder the technic was the same except used that serum and cells were mixed in the for absorption proportions was found anti¬ at 37 C. This method efficient in the absorbing equally as action So the avoidance of inhibitory sheep amboceptor. far, however, difference in is it was there little if any concerned, unsuccessful, being two this between the methods. regard the on 305 serums with The results of Wassermann reactions the same after natural still and on the serums antisheep amboceptor present is Table 1. the had been removed shown in The amboceptor completely at 0 C. did not results of the Wassermann reaction following absorption 37 C. differ in from those at following absorption any particular 7. Rossi: Ztschr. f. 1911, Immunit\l=a"\tsforschung, x, Downloaded From: http://archinte.jamanetwork.com/ by a University of Edinburgh Library User on 06/21/2015 THE ARCHIVES OF 554 INTERNAL MEDICINE on and Table 1.—Wassermann Reaction 305 Serums Before After Removal Natural Antisheep Amboceptor of Positive Doubtful Doubtful Wassermann Reaction Negative . Positive Negative. natural 103 16 2 On serums with 184 antisheep amboceptor.. of 18 1 182 On serums after removal 104 antisheep amboceptor inhibition in Those cases are classed as which positive give complete 0.2 serum the tube c.c. of and with com¬ containing patient's antigen, in the tube c.c. of serum control 0.4 plete hemolysis containing patient's without Those in which there was trace of slight hemolysis antigen. in the tube with and in the and those antigen complete hemolysis control, with inhibition in the tube with showed a trace which, complete antigen, of inhibition in the classed as doubtful Those with are control, positive. with inhibition in the control or are partial hemolysis antigen partial classed as doubtful all others as negative. negative; As is shown Table there was difference in results in but three 1, by of the The cases in which the reaction differed were as follows cases. : 1. Alveolaris.—No of obtainable. The serum con¬ Pyorrhea history syphilis units Wassermann tained 5 of with antisheep amboceptor. reaction, antisheep after removal of doubtful negative; antisheep amboceptor, amboceptor present, positive. lesion fourteen Treatment Syphilitic Laryngitis.—Primary pre¬ years ago. 3 units vious to reaction not known. The serum contained over of Wassermann exact amount not determined. Wassermann the being antisheep amboceptor, reaction with doubtful after removal of antisheep amboceptor present, negative; antisheep amboceptor, positive. 3. Dorsalis.—No of Serum contained 2 units of anti¬ Tabes syphilis. history Wassermann with present, sheep amboceptor. reaction, antisheep amboceptor removal after of doubtful negative; antisheep amboceptor, positive. Table of 423 Wassermann Reactions Done on Serums 2.—Classification Without Amboceptor Absorption Positive Doubtful Doubtful Negative . Positive . Negative Syphilis— . 6 1 0 1 Primary . 20 0 0 1 untreated Secondary, treated O 1 4 . 7 Secondary, . 54 11 1 Tertiary Latent. 24 9 1 26 . 2 1 0 2 Congenital . 1 0 0 0 General paresis . 5 2 1 Tabes Diseases of possibly syphilitic origin— 6 2 0 0 Aneurysm . 9 0 5 Aortic insufficiency . 1 0 0 2 Facial paralysis the 2 0 13 Chronic inflammations of 7 eye. 12 3 not as 177 Diseases diagnosed clinically syphilitic Downloaded From: http://archinte.jamanetwork.com/ by a University of Edinburgh Library User on 06/21/2015 C. H. BAILEY 555 It will be noted that in none of these cases was the variation in results difference between frank and a frank thus a a negative positive reaction, from the results Jacobaeus and other considerably differing reported by seen observers. It will be from Table in which are classified the 2, last 423 Wassermann reactions done without on serums amboceptor that the are similar to those other labora¬ absorption, figures by reported tories the Wassermann method. The which 305 cases on using absorption methods were tried are this number. The three cases classed under among "Diseases not which as or diagnosed clinically positive syphilitic" gave doubtful reactions mention. positive require special Rheumatoid Arthritis.—Wassermann was no of positive; history syphilis of her of obtainable. Patient and in toe complained pain swelling right great three weeks' in ankle and left arm for one On duration, and week. pain right entrance toe somewhat red was was swollen, and tender. There tenderness slight inner the over of left tibia. was normal. five weeks aspect Temperature During in both and several were involved. Patient hospital, elbows, phalangeal joints mixed treatment was on eleven iodid continued nineteen days, potassium being without days longer improvement. was doubtful Gelatinous Carcinoma Rectum.—Wassermann The of positive. lues and the not denied was was made patient history suggestive. Diagnosis past section of of tumor. from excised portion Tonsil.—Wassermann was doubtful This woman Lymphosarcoma of positive. a of one born at one one child dead term, child dead history miscarriage, gave not at 22 months She had two children. Otherwise there (cause known). living the of was in was made from section nothing suggestive past history. Diagnosis of tumor. excised portion In results of the Wassermann reaction it is to unnecessary reporting in detail technic method so well known. the the give employed, being should be There certain it seems to men¬ are, us, however, points which, tioned. In the reactions here the serum was reported guinea-pig always 2 as will titrated and care taken never to use as much as units, very be done if 0.1 is used. The used in all c.c. frequently antigen nearly of the an insoluble fraction of beef heart 305 cases was acetone prepared as recommended The used in the reaction was by Noguchi.8 quantity 0.01 c.c. This was not in four or antigen hemolytic anticomplementary amount times this and had Titrated high antigenic properties. against it with inhibition in one-tenth four one positive serums, gave complete a inhibition in the with second one-thirteenth, quantity used, complete two and with the other inhibition in one-twentieth the complete quan¬ used. tity As the results obtained the methods by amboceptor absorption vary from those other were considerably reported by observers, experiments of introduction of artificial on the done to test the effect the amboceptor Phila. 8. Serum of Ed. 1911. Noguchi: Diagnosis Syphilis, 2, Downloaded From: http://archinte.jamanetwork.com/ by a University of Edinburgh Library User on 06/21/2015 THE OF INTERNAL 556 ARCHIVES MEDICINE Wassermann reaction done with the above Three serums were antigen. which with and selected were this Wassermann frankly positive antigen, were on the 15 reactions done each of these after addition of and 5, 10, units of artificial Beactions were also done on the antisheep amboceptor. same serums without the addition of artificial and after the amboceptor addition of 10 and an amount of which 5, units, using antigen by contained 2 of titration with each serum units for that serum. antigen amount Each serum contained natural but in an antisheep amboceptor less than 1 unit. This was not removed. 1 2 Serum contained units of Wassermann reactions were syphilitic antibody. 10 and 15 with both and weak With the addition of 5, positive strong antigens. units of the reactions were doubtful or with both amboceptor negative antigens, was but the with the inhibition antigen. greater stronger 2 18 of Wassermann reactions Serum contained units syphilitic antibody. even with the addition of 10 and were with the 5, frankly positive strong antigen, units weak 15 of With the the serum a amboceptor. antigen gave frankly posi¬ when not 5 of ambo¬ tive reaction artificial was added. With units amboceptor and the was with 10 15 reaction doubtful, units, negative. ceptor Wassermann 3 more units of Serum contained than 25 syphilitic antibody. with units of reactions were with both 15 antisheep frankly positive antigens amboceptor present. CONCLUSIONS cases From the above and I conclude that it is experiments possible in to reac¬ for human serum affect the Wassermann antisheep amboceptor but that when an of titer is used this is antigen high possible only tion, low and units of anti¬ with serums of content several antibody very two As these in occur but my sheep amboceptor. conditions, experience, when a in I feel is the that, rarely practical work, strong antigen used, of in human a of serum as cause importance antisheep amboceptor nega¬ reactions is As a routine tive in cases not syphilitic procedure, great. the of is Its removal absorption amboceptor unnecessary. is, however, a or doubtful advisable from serums which and give negative reaction, which contain amount of This is large antisheep amboceptor. easily with cells. It is immaterial whether this accomplished digestion sheep by at 0 37 at room is done or C, C, temperature. 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THE VALUE OF ABSORPTION METHODS IN THE WASSERMANN TEST

BAILEY, C. H.
Archives of Internal Medicine – May 1, 1912
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Abstract

THE VALUE OF ABSORPTION METHODS IN THE WASSERMANN TEST* C. H. M.D. BAILEY, NEW YORK is a It conceded most observers that in with by working hemolytic it is advisable to use known amounts of and cells. both system amboceptor Wassermann's method for the of makes use original diagnosis syphilis of of a 5 of with twice c.c. cent. per suspension corpuscles sheep just amount to the of these cells. Since the amboceptor necessary hemolyze of the existence an human of in some discovery antisheep amboceptor it a serums has been whether this additional amount of ambo- question not be sufficient to in with ceptor might produce hemolysis conjunction small residue of not first fixed in the of the reaction. complement stage If this should occur results would thus be obtained in negative syphilitic cases. The of this has rise to several modifi- recognition possibility given cations of the Wassermann reaction. The best-known of these is probably that of He maintained1 that "Wassermann's method Noguchi. original to is from an error the in human serum of a subject arising presence amount of natural of reactivated varying amboceptor capable being by He found that four units of complement." guinea-pig's experimentally the detection of one unit of antisheep prevent amboceptor entirely syphi- litic The modification of the Wassermann technic devised antibody. by him other that of this the has, advantages, among avoiding danger by use of a of human blood cells and the hemolytic serum system consisting of rabbit immunized them. against Several other methods of this source of error have been obviating which still make use of in suggested as the sheep corpuscles original Wassermann method. That of in which each serum is tested for Bauer,2 and artificial immune added serum to those antisheep amboceptor only which show an insufficient amount of natural to antisheep amboceptor the amounts with of cells and give complete hemolysis sheep complement used in the Wassermann will of course be efficient in those cases reaction, in which the human contains serum to just enough amboceptor give some serums contain complete hemolysis. times this As, however, many natural amount of with these the error source of still remains. amboceptor, of *From the St. Luke's F. C. Pathological Department Hospital, Wood, M.D., Director. 1. Jour. Noguchi: Exper. Med., 1909, xi, 392. Bauer: 429. 2. Sem. 1908, med., xxviii, Downloaded From: http://archinte.jamanetwork.com/ by a University of Edinburgh Library User on 06/21/2015 THE ARCHIVES OF INTERNAL MEDICINE Jacobaeus3 the from human proposed absorbing sheep amboceptor the addition of cells 37 C. serum the after at serum, by incubating sheep for one-half then off the cells and with hour; centrifuging proceeding to a the Wassermann reaction the technic. In series according regular cent, of 257 cases he obtained about 10 more this method per positives by than without He asserts that is also removed absorption. complementoid this a modification introduced thus it the of by method, giving advantage is Wechselmann4 in which removed the complementoid by by digesting inactivated human serum with barium Bauer5 had sulphate. previously tried the which Jacobaeus but discarded it on same procedure employed, account of its He declared that this the serum making antihemolytic. liver was much increased the addition of thus extract, property by causing to serums reactions. negative give positive in a S. this method series of obtained Mintz,8 cases, using thirty-eight reactions without The against twenty-five absorption. thirty positive serums were which reacted all syphilitic. positively 305 serums I have tried this method of on absorption amboceptor amount of natural of the The regardless antisheep amboceptor present. results of reaction on of these has been the Wassermann each serums with the result of the reaction the same serum with the on compared natural antisheep amboceptor present. of the contained one or more units of serums Only fifty-three 0.2 natural in that sufficient to c.c, antisheep amboceptor is, hemolyze in 1 c.c. of a 5 cent, of the completely per suspension sheep corpuscles serums was no of one unit of In there presence complement. seventy trace in 0.2 c.c. In of the remaining 182, antisheep antisheep amboceptor com¬ but in a not sufficient to was quantity produce amboceptor present, hemolysis. plete to technic the from the The remove employed antisheep amboceptor 0.5 human was as follows: To c.c. of the after serum serum, patient's 2 c.c. 0.85 cent, 0.1 was added of salt solution and c.c. inactivation, per incubated at 37 for of cells. After the mixture was C. sheep shaking, and the minutes. The cells were then off centrifuged twenty supernatant 0.5 c.c. of the diluted serum fluid used in the Wassermann reaction, used in the tube with and c.c. in the control tube without antigen being the amount of etc., antigen, complement, being correspondingly antigen, to The remainder of reduced one-half the usual the fluid was quantity. used to test the of the In about completeness amboceptor absorption. 3. Jacobaeus: Ztschr. f. Immunit\l=a"\tsforschung,Orig., 1911, viii, Ztschr. f. 1909, 524. 4. Wechselmann: Immunit\l=a"\tsforschung, iii, 5. klin. 1908, Bauer: Berl. Wchnschr., xiv, 6. Mintz: Ztschr. f. 1911, S. Immunit\l=a"\tsforschung, ix, Downloaded From: http://archinte.jamanetwork.com/ by a University of Edinburgh Library User on 06/21/2015 C. H. BAILEY 553 amount of the cases a sufficient of the serum was one-quarter patient's to test a used for in full cubic centimeter. remaining antisheep amboceptor In all but three of the 305 removal of the serums, amboceptor sheep was In each of these 0.2 c.c. showed a faint of trace complete. hemolytic for cells still One additional serum showed power sheep present. very was in a full cubic centimeter but none slight hemolytic remaining power 0.2 demonstrated in c.c. So far the removal from human serum is as of antisheep amboceptor conclude method is efficient. we that the concerned, always may practically The to the method is that bodies are in some way objection inhibitory this which con¬ produced by ("Sachs-Friedberger phenomenon") process at slow there sometimes trace of inhibition siderably hemolysis, being the end of an hour in the control tubes and in serums. The negative difference in between and serums reaction however, positive negative is, to the action not marked render the clear-cut, inhibitory being sufficiently method of which be due as a means error impracticable avoiding may any to the of natural antisheep amboceptor. presence asserts at 0 as Rossi7 that incubation C. for minutes is efficient twenty at 37 in the as incubation while this method absorbing amboceptor C, by not 0.5 the does His method is to add c.c. inhibitory phenomenon appear. to 1.5 of red blood c.c. of the both serum, sheep corpuscles patient's having to 0 been cooled C. This mixture is at this previously kept temperature to for from then and the twenty thirty minutes, rapidly centrifuged, a a serum drawn off with In series of cases Rossi pipette. sixty syphilitic Wassermann and obtained the reaction fifty-six positives fifty positives by after absorption. as as at 37 195 This method of well that was tried on C, absorption, a of Rossi technic was of the above 305 serums. In these the portion followed in detail. With the remainder the technic was the same except used that serum and cells were mixed in the for absorption proportions was found anti¬ at 37 C. This method efficient in the absorbing equally as action So the avoidance of inhibitory sheep amboceptor. far, however, difference in is it was there little if any concerned, unsuccessful, being two this between the methods. regard the on 305 serums with The results of Wassermann reactions the same after natural still and on the serums antisheep amboceptor present is Table 1. the had been removed shown in The amboceptor completely at 0 C. did not results of the Wassermann reaction following absorption 37 C. differ in from those at following absorption any particular 7. Rossi: Ztschr. f. 1911, Immunit\l=a"\tsforschung, x, Downloaded From: http://archinte.jamanetwork.com/ by a University of Edinburgh Library User on 06/21/2015 THE ARCHIVES OF 554 INTERNAL MEDICINE on and Table 1.—Wassermann Reaction 305 Serums Before After Removal Natural Antisheep Amboceptor of Positive Doubtful Doubtful Wassermann Reaction Negative . Positive Negative. natural 103 16 2 On serums with 184 antisheep amboceptor.. of 18 1 182 On serums after removal 104 antisheep amboceptor inhibition in Those cases are classed as which positive give complete 0.2 serum the tube c.c. of and with com¬ containing patient's antigen, in the tube c.c. of serum control 0.4 plete hemolysis containing patient's without Those in which there was trace of slight hemolysis antigen. in the tube with and in the and those antigen complete hemolysis control, with inhibition in the tube with showed a trace which, complete antigen, of inhibition in the classed as doubtful Those with are control, positive. with inhibition in the control or are partial hemolysis antigen partial classed as doubtful all others as negative. negative; As is shown Table there was difference in results in but three 1, by of the The cases in which the reaction differed were as follows cases. : 1. Alveolaris.—No of obtainable. The serum con¬ Pyorrhea history syphilis units Wassermann tained 5 of with antisheep amboceptor. reaction, antisheep after removal of doubtful negative; antisheep amboceptor, amboceptor present, positive. lesion fourteen Treatment Syphilitic Laryngitis.—Primary pre¬ years ago. 3 units vious to reaction not known. The serum contained over of Wassermann exact amount not determined. Wassermann the being antisheep amboceptor, reaction with doubtful after removal of antisheep amboceptor present, negative; antisheep amboceptor, positive. 3. Dorsalis.—No of Serum contained 2 units of anti¬ Tabes syphilis. history Wassermann with present, sheep amboceptor. reaction, antisheep amboceptor removal after of doubtful negative; antisheep amboceptor, positive. Table of 423 Wassermann Reactions Done on Serums 2.—Classification Without Amboceptor Absorption Positive Doubtful Doubtful Negative . Positive . Negative Syphilis— . 6 1 0 1 Primary . 20 0 0 1 untreated Secondary, treated O 1 4 . 7 Secondary, . 54 11 1 Tertiary Latent. 24 9 1 26 . 2 1 0 2 Congenital . 1 0 0 0 General paresis . 5 2 1 Tabes Diseases of possibly syphilitic origin— 6 2 0 0 Aneurysm . 9 0 5 Aortic insufficiency . 1 0 0 2 Facial paralysis the 2 0 13 Chronic inflammations of 7 eye. 12 3 not as 177 Diseases diagnosed clinically syphilitic Downloaded From: http://archinte.jamanetwork.com/ by a University of Edinburgh Library User on 06/21/2015 C. H. BAILEY 555 It will be noted that in none of these cases was the variation in results difference between frank and a frank thus a a negative positive reaction, from the results Jacobaeus and other considerably differing reported by seen observers. It will be from Table in which are classified the 2, last 423 Wassermann reactions done without on serums amboceptor that the are similar to those other labora¬ absorption, figures by reported tories the Wassermann method. The which 305 cases on using absorption methods were tried are this number. The three cases classed under among "Diseases not which as or diagnosed clinically positive syphilitic" gave doubtful reactions mention. positive require special Rheumatoid Arthritis.—Wassermann was no of positive; history syphilis of her of obtainable. Patient and in toe complained pain swelling right great three weeks' in ankle and left arm for one On duration, and week. pain right entrance toe somewhat red was was swollen, and tender. There tenderness slight inner the over of left tibia. was normal. five weeks aspect Temperature During in both and several were involved. Patient hospital, elbows, phalangeal joints mixed treatment was on eleven iodid continued nineteen days, potassium being without days longer improvement. was doubtful Gelatinous Carcinoma Rectum.—Wassermann The of positive. lues and the not denied was was made patient history suggestive. Diagnosis past section of of tumor. from excised portion Tonsil.—Wassermann was doubtful This woman Lymphosarcoma of positive. a of one born at one one child dead term, child dead history miscarriage, gave not at 22 months She had two children. Otherwise there (cause known). living the of was in was made from section nothing suggestive past history. Diagnosis of tumor. excised portion In results of the Wassermann reaction it is to unnecessary reporting in detail technic method so well known. the the give employed, being should be There certain it seems to men¬ are, us, however, points which, tioned. In the reactions here the serum was reported guinea-pig always 2 as will titrated and care taken never to use as much as units, very be done if 0.1 is used. The used in all c.c. frequently antigen nearly of the an insoluble fraction of beef heart 305 cases was acetone prepared as recommended The used in the reaction was by Noguchi.8 quantity 0.01 c.c. This was not in four or antigen hemolytic anticomplementary amount times this and had Titrated high antigenic properties. against it with inhibition in one-tenth four one positive serums, gave complete a inhibition in the with second one-thirteenth, quantity used, complete two and with the other inhibition in one-twentieth the complete quan¬ used. tity As the results obtained the methods by amboceptor absorption vary from those other were considerably reported by observers, experiments of introduction of artificial on the done to test the effect the amboceptor Phila. 8. Serum of Ed. 1911. Noguchi: Diagnosis Syphilis, 2, Downloaded From: http://archinte.jamanetwork.com/ by a University of Edinburgh Library User on 06/21/2015 THE OF INTERNAL 556 ARCHIVES MEDICINE Wassermann reaction done with the above Three serums were antigen. which with and selected were this Wassermann frankly positive antigen, were on the 15 reactions done each of these after addition of and 5, 10, units of artificial Beactions were also done on the antisheep amboceptor. same serums without the addition of artificial and after the amboceptor addition of 10 and an amount of which 5, units, using antigen by contained 2 of titration with each serum units for that serum. antigen amount Each serum contained natural but in an antisheep amboceptor less than 1 unit. This was not removed. 1 2 Serum contained units of Wassermann reactions were syphilitic antibody. 10 and 15 with both and weak With the addition of 5, positive strong antigens. units of the reactions were doubtful or with both amboceptor negative antigens, was but the with the inhibition antigen. greater stronger 2 18 of Wassermann reactions Serum contained units syphilitic antibody. even with the addition of 10 and were with the 5, frankly positive strong antigen, units weak 15 of With the the serum a amboceptor. antigen gave frankly posi¬ when not 5 of ambo¬ tive reaction artificial was added. With units amboceptor and the was with 10 15 reaction doubtful, units, negative. ceptor Wassermann 3 more units of Serum contained than 25 syphilitic antibody. with units of reactions were with both 15 antisheep frankly positive antigens amboceptor present. CONCLUSIONS cases From the above and I conclude that it is experiments possible in to reac¬ for human serum affect the Wassermann antisheep amboceptor but that when an of titer is used this is antigen high possible only tion, low and units of anti¬ with serums of content several antibody very two As these in occur but my sheep amboceptor. conditions, experience, when a in I feel is the that, rarely practical work, strong antigen used, of in human a of serum as cause importance antisheep amboceptor nega¬ reactions is As a routine tive in cases not syphilitic procedure, great. the of is Its removal absorption amboceptor unnecessary. is, however, a or doubtful advisable from serums which and give negative reaction, which contain amount of This is large antisheep amboceptor. easily with cells. It is immaterial whether this accomplished digestion sheep by at 0 37 at room is done or C, C, temperature. 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Journal

Archives of Internal Medicine – Unpaywall

Published: May 1, 1912

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