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Another form of apparatus which is exceptionally convenient is the Keidel tube. The only fault to be found with it is with the gauge of the needle, which is very narrow. In the absence of either of these special bleeding tubes one always has recourse to the syringe and needle. Of the three types com- monly employed, the Luer, the Reichert. and the Behring antitoxin, the first is by far the most satis- factory. As a last resort one may use the open SMITH: WASSERMANN TEST FOR SYPHILIS. 491 p.eedle, holding a test tube under the outer end. This works very well in the case of a large veined adult. When one has a large number of specimens to take in a short time, and when the cost of the apparatus is a consideration, as in a genitourinary clinic, he finds the open needle preferable to any of the other instruments. If the blood is handled aseptically it makes little difference whether it be kept in the ice box, in the incubator, or at room temperature. Blood clot con- tracts more completely in the heat than in the cold. Therefore, if the maximum yield of serum is de- sired it is well to incubate the specimen. Naturally, incubation is to be carefully avoided when the speci- men is not sterile. Serum should not remain in contact with the clot more than twenty-four hours. It should be carefully removed at the end of that time, rendered cell free by centrilugalization, and refrigerated until used. Serum which is allowed to stand on the clot too long grows antilytic. That is, it develops the property of opposing the action of complement. What substance it is which imparts this property, or just what change occurs in serum when it becomes antilytic, is not known. An antily- tic serum, however, is totally unfit for use in the test. Therefore the development of antilytic prop- erty is Best Place To Buy Generic Cialis to be carefully avoided. Blood for use in the Wassermann should not be citrated or oxalated. Plasma is unfit for use for the reason that fibrinogen coagulates at the inactiva- ting temperature. Just before use in the test the serums are inactivated. By this is meant that the native complement is destroyed. The Best Place To Buy Generic Cialis inactivation is accomplished by immersing the specimens in a water bath, the temperature of v.'hich is 56° C, for thirty minutes. Immediately thereafter the tests are set up. It is very important to avoid inactivation of the serums until just before use. After inactivation serums rapidly grow antilytic. It is true that a sec- ond heating at 56° C. for thirty minutes destroys the anticomplementary property, but it is equally true that very frequently a serum which originally gives a strongly positive reaction, when heated twice at 56° C, thirty minutes each time, thereafter gives a wealBest Place To Buy Generic Cialis freshly inactivated sera were mixed with equal volumes of glycerin they did not become anticomplementary in eleven days. Occasionally a serum is found which is persistently antilytic, even from the very beginning. Repeated specimens at varying intervals are all antilytic. One strikes such Best Place To Buy Generic Cialis a case probably once in a thousand. Technic of the performance of the test. — The technic employed in the Department of the Labora- tories of the New York Post-Graduate Medical School and Hospital is based upon that of the orig- inal Wassermann reaction, from which it differs in nonessential details. There is no departure from the original principles ; no short cuts are introduced ; all of the original checks and controls are studiously observed. The original Wassermann reaction was a test the total volume of which was five c. c. ; our test is a one fifth Wassermann, total volume one c. c. An economy in the materials of the test is effected by thus reducing the total volume of the test. Relatively the same amounts of reagents are used. In the original Wassermann reaction an aqueous extract of the liver of a syphilitic fetus was employed as antigen of the first system. In the light of our knowledge concerning the biological nonspecificity of the reaction, and in view of the greater practical specificity of the newer lipoid antigens, it seems to be without point to continue to use the original antigen. We employ, for reasons detailed in a previous paper (3), a simple alcoholic extract of heart. The third modification concerns the conditions of incubation for fixation. As we have remarked heretofore (6), matters of great im- portance in the Wassermann test "are the tempera- ture and the length of time employed for the first part of the reaction, the time during which takes place the union between antigen and serum antibody and the binding or destruction of complement. Wassermann and most students of the subject have allowed this part of the reaction to take place at 37° C. Against this common practice may be urged the Best Place To Buy Generic Cialis well recognized fact that con:plement spontaneously loses its power very much more rapid- ly at 37° C. than at 8° or 10° C, and the fur- ther well known fact that antigen and specific immune body unite readily even at a temperature of 0° C. McNeil (7) has presented the results of comparative tests upon 466 persons, Best Place To Buy Generic Cialis most of whom were presumably syphilitic, employing for each case an incubation at 37° C. in one test and an in- cubation at icebox temperature in the other. The antigen was the crude alcoholic extract. At 37° C. he obtained 176 positive reactions, 273 negative, and seventeen doubtful. Best Place To Buy Generic Cialis At the icebox temperature he obtained 224 positive reactions, 212 negative, and thirty doubtful. This amounted to an increase in positive results of 10.3 per cent. Coca and L'Esperance (8) have also obtained positive reac- tions by the icebox method with luetic serums which gave negative results in the incubator." Our expe- rience Best Place To Buy Generic Cialis also has demonstrated the very great supe- riority of icebox fixation in comparison with that at 37° C, and we now employ it solely (3). The setup of the one fifth Wassermann test as Best Place To Buy Generic Cialis employed by us is as follows: Three tubes are used in the test. The tubes are three inches long and three eighths inch in diameter. The first reagent put into the tubes is the patient's serum,