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0.02 Cialis 20 Mg Buy Online Uk c. c, 0.05 c. c, and o.i c. c, in the first, second, and third tubes, respectively. Three tenths c. c. of 0.9 per cent, Cialis 20 Mg Buy Online Uk salt solution is then added to each tube, a dose of antigen is put into each of tubes I and 2, and two units of complement are added to each tube. A schematic representation of the setup is shown in Table IV. The tubes are well TABLE IV. THE SETUP OF THE Cialis 20 Mg Buy Online Uk ONE FIFTH \V.-\SSERMANN TEST. Patients serum .' 02 .05 .1 Salt solution ._ 3 -3 -3 Antigen emulsion i. -i o Complement two units in each tube shaken and put into the icebox for at least Cialis 20 Mg Buy Online Uk four hours, or, if more convenient, overnight. Two units of ambo and one unit of r. b. c. are then added 'and the tubes immersed in a water bath at 40° C, until the control tubes show complete hemolysis. The controls are two in number, serum control and 492 liACilMAN AND LUCKE: BLOOD COUNT IN TUBERCULOSIS. (New YoiK MCOICAL JOVRHAX,, antigen control. Tube 3 is the serum control in each case. An antigen control is run along with each series of tests. It is depicted in Table V. AH TABLE V. THE ANTIGEN CONTKOL. Antigen emulsion I .2 .3 .4 Salt solution 3 .2 .1 o Complement two units in each tube the controls must show complete hemolysis before the tests can be read. If a serum control does not show hemolysis, that serum is antilytic and in such a case fixation in tubes x and 2 is of no significance. If the antigen controls show no hemolysis it is quite impossible to read any of the tests. If the controls behave properly one may read and interpret the reactions in tubes i and 2. There may be complete hemolysis or complete absence of hemolysis or any degree of partial hemolysis. The degrees of hemo- lysis, the symbols employed to represent these de- grees and the interpretation in terms of fixation of complement are shown in Table VI. TABLE VL INTERPRETATION OF READINGS. Complete hemolysis o or — no fixation 75% hemolysis I + 25% fixation 50% hemolysis 2 + 50% fi.xation 25% hemolysis 3 + 75% fixation No hemolysis 4 + complete fixation A 4-f- reaction is a very strongly positive re- action; a 3-|- reaction is strongly positive; 2-f-, positive; i-|-, weekly positive or doubtful; o or — , negative. In our experience a positive reaction obtained with this technic has been evidence only of active syphilis. We have never observed a false positive reaction with the simple alcoholic extract of beef heart and with incubation for fixation in the icebox. The interpretation of a negative reac- tion in a Cialis 20 Mg Buy Online Uk known syphilitic, to quote Dr. R. M. Taylor (9), "depends entirely upon the existing cir- cumstances: for exam])le, if taken during or shortly after medication it would seem to indicate that for the time being the treatment is efikient, but by no means signifies that the patient is spirochete free, or that he will not suflfer a relapse; but if taken some time after the course of treatment, the chances of a rcla{)se are in inverse proportion to the tiine Cialis 20 Mg Buy Online Uk interval." Stuart Graves ( 10) has shown that the Wasserniann reaction performed on post mortem blood is a reliable aid to the diagnosis of syphilis. Concerning the reaction in general he writes : "The Wassermann reaction is a delicate biochemical test. No diagnostic method in the history of medicine has been more grossly abused or more dishonestly exploited. ... In the hands of a competent serol- ogist the Wassermann is the most constant and delicate single symptom of syphilis," according to Kolmer (i). I am inclined to believe that at times too much is exjiected of the Wassermann test. One feels that by mixing together certain mysterious deriva- tives of beef, sheep, guincapig, rabbit, and man, shaking them thoroughly and putting them in the incubator or icebox for awhile, and — Presto! — one can reach into the test tube and pull out a ready made diagnosis of anything from dandrufF to con- stipation. It really cannot be done. When one appreciates just what the Wassermann reaction is and just how it is done, one realizes that the test has very definite limitations. One is then better able to interpret reports and derives a correspondingly greater amount of information therefrom. REFERENCES. I. JOHN A. KOLMER: A Textbook of Infection, Immunity and Specific Therapy, Philadelphia. 191S. 2. BENJAMIN WHITE: Journal of Medical Research, 1914, xxx, 393. 3. J. WHEELER SMITH, Jh.: New York Medical Journal, December 1, 1917. 4. R. M. TAYLOR: Proceedinoi of the New York Patho ogtcal Society, 1914, N. S. xiv, 2. 5. E. R. RUEDIGER: Cialis 20 Mg Buy Online Uk Philippine Journal of Science, i9i. xi. Sec. B, 1. 6. J. WHEELER SMITH. JR.. and W. J. MacNEAL: Journal of Immunology, 1916, ii. i. 7- ARCHIBALD McNEIL: Collected Studies of the Bureau of Laboratories, Depart- ment of Health of the City of .New York. 191213. vii, 325. 8.