Wassermann test

“ Even while we concede the value of generations of experience with syphilis in determining the probable risk of infection, it is a duty to investigate thoroughly by the modern methods, such as the Wassermann blood test, the condition of all members of a family in which syphilis has appeared. This means, for example, that even though the husband with syphilis may have married years after the usual period of infectiousness has passed, his wife, though outwardly healthy, should have a Wassermann test, and his children would be none the worse for an examination, even though they seem normal. ”

“ Repeated negative Wassermann tests on the blood over several years, especially after treatment is stopped, are an essential sign of cure. This must be reinforced, as a rule, by a searching examination of the nervous system, including a test on the fluid of the spinal cord. This is especially necessary when we have used some of the quick methods of cure, like the abortive treatment. When we have used the old reliable course, it is less essential, but desirable. Can we ever say to a patient in so many words, "Go! ”

“ There is abundant evidence that the Wassermann test is a reliable means of establishing a diagnosis of syphilis.
A definitely positive reaction can usually be obtained between the fifteenth and thirtieth day after the appearance of the primary lesion, and as time goes on it becomes more marked. During the secondary period the reaction is practically always positive. In the tertiary stage also it is positive except in so far as it is modified by the results of treatment. In para-syphilitic lesions such as general paralysis and tabes a positive reaction is almost always present. ”

“ Difficulties of the Test.—The Wassermann blood test for syphilis is one of the most complex tests in medicine. The theory of it is beyond the average man's comprehension. A large number of factors enter into the production of a correct result, and the attaining of that result involves a high degree of technical skill and a large experience. It is no affair for the amateur. The test should be made by a specialist of recognized standing, and this term does not include many of the commercial laboratories [Pg 56] which spring up like mushrooms in these days of laboratory methods. ”

“ Complement Fixation.—Complement fixation tests have been employed in the diagnosis of several tropical diseases but do not seem to be at present sufficiently reliable or practical with the exception of that for yaws and tularaemia. The chief difficulty with complement fixation tests for suspected sera is to obtain a reliable antigen. Should we later on be able to prepare bacterial antigens as satisfactory as Noguchi’s acetone-insoluble antigen is for the Wassermann test there may be a field for such tests in tropical pathology. ”

“ We believe that no cerebrospinal fluid examination is complete for clinical purposes without the gold sol test.
The Wassermann reaction as carried out in the Wassermann Laboratory is based on the principles of the original method—the only essential modification consists in the employment of cholesterinized alcoholic extracts of human hearts as antigen instead of aqueous extracts of foetal livers from cases of congenital syphilis. Experience has shown that properly standardized antigens made from human hearts are much more sensitive in the detection of true cases of syphilis. ”

“ Voss replied, irritably. “Refute me on my own ground, if you don’t mind. As a matter of fact, I saw no one face to face except Wahnschaffe’s brother, Wolfgang. He invited me, ostensibly to obtain information, but in fact to test me. A remarkable chap; representative to the last degree. He is penetrated by the unshakable seriousness of those who have counted every rung of the social ladder and measured all social distances to a millimetre. Ready for anything; venal through and through; stopping at nothing; cruel by nature, and consistent through lack of mind. ”

“ Serum Diagnosis--Wassermann Reaction.#--Wassermann found that if an extract of syphilitic liver rich in spirochaetes is mixed with the serum from a syphilitic patient, a large amount of complement is fixed. The application of the test is highly complicated and can only be carried out by an expert pathologist. ”

“ Of course the most important test is the Wassermann of the spinal fluid and every one should bear in mind the marked complement fixation power of the spinal fluid of paretics. In such a fluid we almost always obtain a positive reaction where quantities of 0.2 cc. or less are employed, while with locomotor ataxia or cerebro-spinal lues amounts of 0.5 to 1 cc. are generally required to give a positive test. It is not necessary to inactivate spinal fluid. ”

“ With a modification of the Wassermann technique where the tests were allowed to stand for four hours at ice box temperature to fix complement, instead of the usual one hour at 37°C. in the incubator, 224, or 48 percent gave positive reactions, 212, or 45.4 percent gave negative reactions and 30, or 6.4 percent gave doubtful reactions, showing an increase of 10.3 percent of positive reactions for syphilis over the method of fixing complement at 37°C. The same sera were tested by the complement fixation test for gonorrheal infection with the result that 134 or 29 percent gave positive reactions ”

“ My opinion is that all human beings have equally deep perceptions. There is no difference in sensitiveness to pain; there is only a difference in the consciousness of that sensitiveness. There is, one may say, no difference in the method of bookkeeping, only in the accounting.”
With lowered head he went a pace nearer to Niels Heinrich, who remained quite still, and continued, while a veiled smile hovered over his lips: “Don’t misunderstand me. I don’t desire to exert the slightest influence on your decisions. What you do or fail to do is your own affair. ”

“ Standing around him were the physician, Frau Hadebusch, and Philippina. The doctor said something at which Daniel shook his head. It sounded like: “Unfortunately I cannot keep the sad news from you.” Daniel did not understand him; he drew his lips apart, and thought: “The idea of dreaming such disordered stuff!”
“Mother and child are both dead,” said the old physician, with tears in his eyes. “Both dead. It was a boy. Science was powerless; nature was hostile and the stronger of the two.” ”

“ The neck of Niels Heinrich was like an emptied tube, slack and quivering.
Their eyes met. Words died. The air roared.
Suddenly Christian blew out the lamp. The sudden darkness was like the thud of an explosion. “You were right,” he said. “The light would betray us to any passerby. Now we are quite secure, from any outside thing, at all events. What happens here now concerns no one but ourselves. You can do as you choose. You can draw your revolver as you did the other day and fire. ”

“ And face to face with him was this man. We’ll see; we’ll measure our strength.
He reflected for some moments; then he flung out both hands, and the pearls were in his possession. There was a soft clinking, a gathering up, a shoving, and they disappeared in his trousers pocket. The pocket stuck out, but his coat hid the fact. If the man looked into the drawer and raised an alarm, why, one could fling the stuff back at him.
When Christian returned, Niels Heinrich was sitting on a chair and smoking. ”

“ It was a bottomless silence into which Niels Heinrich had sunk. He suddenly remembered the moment in which the impulse to murder the machine had come upon him. With utter clearness he saw again the steel parts with their film of oil, the swiftly whirling wheels, the whole accurately functioning structure that had, somehow, seemed hostile and destructive to him. Why that image of all others came to him now, and why he remembered his vengeful impulse with an access of shame now—he did not understand.
Christian was speaking again: “So all that does not concern me at all. You need have no fear. ”

“ If some one went to him and whispered that name, Niels Heinrich Engelschall, into his ear, he would probably collapse as under a paralytic stroke. Of course, as I have thought it out, it is an exaggeration. But try to imagine him. One must try to grasp men and things imaginatively. Very few people do it; they cheat themselves. I see him as robbed of his very soul, as so poverty-stricken that the thought is scarcely bearable. You will reply: he is an idiot, irresponsible, with an undeveloped sensorium—more animal than human. Even science uses that argument ”

“ To summarize the case, then, we have a man of thirty years of age who has shown criminalistic and anti-social tendencies since childhood, whose general physical and neurological examination is negative (excepting the laboratory tests) , whose mental examination shows no psychotic symptoms, and who seems not feebleminded. In other words, with the exception of the serological and chemical findings in the blood and cerebrospinal fluid, there is nothing to suggest that he is more than a “criminal type.”
Wassermann reaction in blood serum positive. ”

“ Whiteness was a lie.
He got up and walked through the room. The glitter of the sunlight came insolently from the whiteness, and the room was filled with its lying shimmer. He hated it.
He stopped and listened and his eyelids twitched. Something floated before his mind, knocked at its door—not so much a forgotten thing as one suppressed and throttled. From his trousers pocket he drew forth a round, tightly-rolled, blackish brown object. He looked at it and began to shudder. For a moment his eyes had the same brooding look as when he regarded the chessmen. ”

“ Yes, quite clearly and irrefutably, I got the feeling of murder from you. Am I mistaken?”
Niels Heinrich uttered no sound. He could not move. Roots seemed to grow from the floor and entwine themselves [337] about the chair on which he sat, to creep about his legs, and hold him in an iron grip.
Christian arose. “All that is useless,” he said, taking a deep breath.
“What? What is useless?” Niels Heinrich murmured. “What? What then?” The blood in his body grew chill.
His arms pressed to his side, his hands joining below, Christian stood there, and whispered: “Speak! Tell me!” ”

“ Since I have known you, the thought has acquired a deeply serious significance. All this may sound [82] strange to you and even discordant. You do not brood nor take yourself spiritually to task; and that is the incomprehensible thing about you. Yet I know none but you whom I would make the arbiter of my conscience and whom I would ask: Have I done right?”
XXIII
The latch must have been left open. Isolde Schirmacher had been the last to go out. Twilight had just fallen when the door of the room opened, and Niels Heinrich entered.
Karen did not get up. She looked over at him. ”

“ The glass door was flung shut.
“I shall see what goes on in there,” said Christian, and mounted the steps to the door. Crammon had only time to utter a horrified warning. But he followed. The reek of [367] cheap whiskey struck him as he entered the room behind Christian.
Beside tables and on the floor crouched men and women. In every corner lay people, sleeping or drunk. The eyes which were turned toward the newcomers were glassy. The faces here looked like lumps of earth. The room, with its dirty tables, glasses, and bottles had a colour-scheme of scarlet and yellow. ”

“ Niels Heinrich snarled at her. “You’d make a dog laugh.” He frowned, and said with assumed indifference, “Look and see if the cards say something about a Jew wench.”
The widow Engelschall shook her head in astonishment. “No, my boy, nothing like that.” She turned the cards again. “No. Another ten and a queen o’ hearts—that might mean a money order. Lord love us—three more queens. You always was a great one for the women. And that reminds me that red Hetty asked after you to-day. ”

“ The formal phraseology hid Herr Wahnschaffe’s inner uncertainty and shame.
Girke sat down. His speech was tinged with the dialect of Berlin. “We have been very active. There is plenty of material. If you’ll permit me, I can submit it at once.” He took a note-book out of his pocket, and turned the leaves.
His ears were very large and stood off from his head. This fact impressed one as a curious adaptation of an organism to its activity and environment. ”

“ The vagabond cursed, the hurdy-gurdy man dragged his straw sack toward the door, the agent snapped his [138] fingers and said: “Hurry, good people, hurry! Let’s have no tender scenes! My supper is getting cold!”
XXI
Christian and Ivan Becker entered. They forced their way through the staring crowd. Christian had on his costly fur-coat. The agent stood still and his jaw dropped. His men instinctively touched their caps. Ivan Michailovitch wanted to close the door, but the woman in the big hat stood on the threshold and would not stir. ”

“ You want to get the police here, do you? That’d be fine for us all, eh? You’re a bit crazy, eh? The girl can go with the gentlemen, if they’ll pay her score. Two glasses champagne—that’s one mark fifty. And that ends it.”
Crammon laid a two-mark piece on the table. Karen Engelschall had put on her hat, and turned toward the door. Christian and Crammon followed her, and the proprietor followed them with sarcastic courtesy, while the two sturdy bar-tenders formed an additional bodyguard. A few half-drunken men sent the strains of a jeering song behind them. ”

“ Christian opened the door, and Crammon drew from his back pocket the Browning revolver that was his constant companion. They passed through the hall and stopped on the threshold of the outer room. Mesecke had vanished. Many arms had finally expelled him. The woman from whom he had been trying to get money was washing the blood from her face. The old man who had been beaten when he had pleaded for her said consolingly: “Don’t yuh howl, Karen. Things’ll get better. ”